眶下蒂鼻唇沟瓣修复鼻缺损的临床研究

目的 :探索鼻缺损修复重建的新方法 ,评价眶下蒂鼻唇沟瓣修复鼻缺损的临床应用价值。方法 :对 10例患者应用眶下血管皮下蒂鼻唇沟瓣经皮下隧道转移修复其鼻部组织缺损。其中单纯皮肤皮下软组织缺损者 4例 ,鼻全层洞穿复合组织缺损者 6例。结果 :10例皮瓣全部存活 ,最大皮瓣面积 5cm× 2 .5cm ,皮瓣色泽、质地与周围皮肤相仿 ,触温觉存在 ,供区瘢痕隐蔽 ,形态恢复满意。结论 :眶下血管皮下蒂鼻唇沟瓣作为邻近轴形皮瓣 ,具有众多优点 ,是鼻缺损修复重建的理想方法之一。     

Extended nasolabial flap compared with the platysma myocutaneous muscle flap for reconstruction of intraoral defects after release of oral submucous fibrosis: a comparative study

We compared extended nasolabial flaps and coronoidectomy with platysma myocutaneous muscle flaps in the management of 20 randomly selected patients with histologically confirmed oral submucous fibrosis. Ten patients were treated by release of fibrous bands, bilateral coronoidectomy, and reconstruction with an extended nasolabial flap (nasolabial group), and the other 10 by bilateral release of fibrous bands, coronoidectomy, and reconstruction with a platysma myocutaneous muscle flap (platysma group). In the nasolabial group the mean preoperative interincisal mouth opening was 12 (range 3–14) mm, and in the platysma group it was 11 (3–13). All 20 patients were given vigorous postoperative physiotherapy, and were followed up for 3 years. The interincisal mouth opening improved to 47 (35–45) mm in the nasolabial group and 48 (41–52) mm in the platysma group. The procedures were equally effective in the management of the oral submucous fibrosis, except that the extraoral scar was not aesthetically acceptable in the nasolabial group.     

Reconstruction of intraoral defects after cancer surgery using cervical pedicle flaps.

PURPOSE: This article reports the results of using cervical myocutaneous flaps for reconstruction of small- and medium-sized oral defects. PATIENTS AND METHODS: One hundred thirty-one cervical pedicle flaps were used for reconstruction of the defects after resection of oral cancer. Primary sites of the lesions were the tongue, buccal mucosa, floor of the mouth, and lower gingiva. RESULTS: Infrahyoid myocutaneous flaps were used in 53 cases, sternocleidomastoid flaps in 47 cases, and platysma flaps in 31 cases. Among the 131 patients, there was complete necrosis of the skin paddle in 5 cases and partial necrosis in 7 cases. The success rate was 92.5%, 89.4%, and 90.3%, respectively for the 3 types of flaps. CONCLUSIONS: It was concluded that cervical pedicle flaps have clinical value in selected patients needing reconstruction of small- and medium-sized defects after intraoral cancer surgery.     

Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report

A 34-year-old woman presented with a progressive oral ulcer, and redness and swelling of the skin over the mandible. Radiological and histological examination showed adenoid cystic carcinoma of the mandible and floor of the mouth with extensive invasion. We radically resected the tumour with sufficient margins, and cut off segments of fibula, reshaped them and fixed them into the mandibular angles bilaterally. We used three perforator flaps, (the soleus muscle, the third, and fourth perforator flaps) to reconstruct the defects of the tongue, mentum, and oral floor, respectively. Recovery was good postoperatively, and there was no infection or any other complications.     

Reconstruction of defects after hemiglossectomy using a chimeric vastus lateralis free flap

Although the anterolateral thigh flap (ALT) is used by many instead of the radial forearm free flap in the reconstruction of defects after hemiglossectomy, the shape of the patient's body invariably dictates the volume of tissue harvested. Here a chimeric vastus lateralis free flap is described as an alternative. For the surgeon familiar with the anatomical territory of the ALT, this may be a useful option in certain clinical circumstances.     

Reconstruction of complex oro-facial defects using the myocutaneous sub-mental artery flap

Oro-facial defects require reconstruction that provides suitable colour match and texture. Moreover inner and outer cheek lining and bulk are key considerations. In cases of severe oro-facial infections concomitant mandibular abnormality, for example trismus, can mandate the need for tissue to obturate mandibular defects. We assessed the use of the myocutaneous sub-mental artery flap (MSA) in non-oncological patients with such defects. Twenty two consecutive patients were included in this case series. All patients were survivors of Cancrum Oris (NOMA). Demographic details, nutritional status and co-morbidities were recorded. Defects were classified according to the tissues destroyed; cheek, mandible, oral cavity, lip(s), nose and eye(s). Simultaneous procedures carried out were recorded. The surgical anatomy of the MSA is described. All patients had composite defects of the cheek and oral cavity plus another local anatomical structure. Adjunct procedures such as trismus release were carried out in 18/22 patients. Four patients required a return to theatre. There was no trismus recurrence observed. No flap losses were incurred. The MSA is a robust flap with minimal incidence of major complications. The MSA negates the need for microsurgical tissue transfer. Furthermore the MSA provides adequate bulk to obturate these defects. Future applications of the MSA may include complex oro-facial oncological defects.     

The nasolabial flap

The nasolabial flap is a straightforward and time-tested reconstructive option suitable for a variety of facial and oral defects. The superiorly and inferiorly based variants are well described in the literature and offer a rapid and reliable alternative to time-consuming microvascular free flaps and less esthetic skin grafts. Despite newer and more complex alternatives, the nasolabial flap maintains its prominent position in the reconstructive armamentarium of the oral and maxillofacial surgeon.     

The inferiorly and superiorly based nasolabial flap for the reconstruction of moderate-sized oronasal defects

Purpose: The usefulness of the inferiorly or superiorly based nasolabial flap for the unilateral or bilateral reconstruction of local extraoral and intraoral defects was evaluated.Patients and Methods: In a 10-year period, 22 flaps were used in 15 patients to cover defects of the floor of the mouth, nose, and chin. Fourteen bilateral and two unilateral flaps were inferiorly based, and six unilateral flaps were superiorly based.Results: Dehiscence, which occurred in one case, and obstructive sialadenitis which occurred in another, were the main complications.Conclusion: The nasolabial flap is a useful procedure for the reconstruction of moderate-sized oronasal defects because of its simple elevation, proximity to the defect, and versatility.     

应用对侧逆行内眦动脉瓣修复面中部皮肤癌术后缺损

目的:评价对侧逆行内眦动脉瓣用于修复面中部皮肤癌术后中到大型缺损的可行性。方法:12例面中部皮肤癌患者,男9例,女3例,年龄55～76岁。其中,基底细胞癌7例,鳞状细胞癌4例,恶性黑色素瘤1例。手术切除肿瘤后,采用对侧逆行内眦动脉岛状皮瓣修复缺损。缺损大小为3.0cm×3.0cm～5.0cm×7.0cm,皮瓣大小为2.0cm×4.0cm～4.0cm×6.0cm。结果:12例移植皮瓣均成活,随访6～12个月,平均8.5个月。多数皮瓣血供良好,功能正常,色泽、质地良好,术后供区瘢痕隐蔽。结论:对侧逆行内眦动脉瓣修复面中部皮肤癌术后中到大型缺损简单、安全,疗效稳定。     

The myocutaneous platysma flap for the reconstruction of intraoral defects after radical tumour resection

After performing 54 myocutaneous platysma flaps for reconstruction of intraoral defects following tumour surgery, the results, with reference to the postoperative outcome, are presented. Interest is focused on the anatomical basis of the flap's pedicle and its relevance for the indication of this method.     

Reconstruction after extended orbital exenteration using a fronto-lateral flap

Orbital exanteration is usually performed for advanced neoplasms of the eyelids and is associated with significant distress for patients. Its reconstruction should aim for functional and aesthetic results and safety for further oncological treatment. The ideal reconstruction should provide adequate cutaneous covering, short healing time, obliteration and closure of communication with facial sinuses and nasal cavity, resistance to radiotherapy, low morbidity and favorable rehabilitation. In 10 patients, a flap based on the frontal branch of the temporal artery was used for immediate reconstruction after orbital exenteration. Flap demarcation began through the frontal midline from the glabella to 0.5 cm above the hairline. Its elevation was performed in a plane above the periosteum and galea, including skin, subcutaneous tissue and frontal muscle. It was rotated tension-free over the defect. In all patients, adequate closure of the defect and obliteration of the orbital cavity was achieved. There was no flap loss or major complications. The lateral frontal flap is easy and fast to execute, with a reliable blood supply and reproducible technique. Its main applicability is for patients with orbital defects and high surgical risks with contraindications for microsurgical reconstruction.     

Reconstruction after total parotidectomy using a de-epithelialized free flap

INTRODUCTION: Total parotidectomy has aesthetic and functional sequelae, including Frey' syndrome and soft tissue depression of the region. The aim of repair is to reduce these problems, importing tissue into the surgical field to fill the region and to avoid Frey's syndrome. The soft tissues to use are those which are not resorbed in order to have a stable aesthetic result. OBJECTIVE: To propose a new method for avoiding negative functional and aesthetic sequelae of total parotidectomy. PATIENTS: Two patients underwent total parotidectomy because of recurrent sialoadenolithiasis in one case and for adenocarcinoma in the other. Immediate repair was obtained with a de-epithelialized parascapular free flap: both cases required thinning of the flap secondarily under local anaesthesia. RESULTS: Aesthetic results were good in both cases. No patient developed Frey's syndrome. CONCLUSION: Among the many techniques that have been proposed for this purpose, the de-epthelialized parascapular free flap guarantees an adequate amount of tissue with good vascularization and leads to a pleasing and stable result.     

胸锁乳突肌瓣在腮腺良性肿瘤切除术中的应用

本文观察了胸锁乳突肌瓣即刻转移修复腮腺良性肿瘤切除术后缺损的临床疗效。对24例腮腺良性肿瘤患者进行瘤体切除+部分腮腺或腮腺浅叶或全腮腺切除+面神经解剖,同期行即刻胸锁乳突肌瓣转移修复腮腺切除术后局部缺损,术后随访6～10月观察发现,24例患者均无涎瘘和Frey综合征发生,伤口愈合良好,术区无凹陷畸形,瘢痕隐蔽,外形满意,颈部功能正常。胸锁乳突肌瓣修复腮腺良性肿瘤术后局部缺损,能改善局部凹陷畸形,并能有效预防Frey综合征的发生。