供区免植皮的游离前臂皮瓣技术在头颈肿瘤修复中的运用

目的：介绍一种头颈肿瘤手术中游离前臂皮瓣供区时采用邻近双叶瓣替代游离植皮的技术。方法：在制备游离前臂皮瓣同期取前臂皮瓣缺损区域的临近尺侧双叶瓣修复缺损,避免前臂皮瓣供区植皮。双叶瓣大叶用于修复前臂皮瓣的供区缺损,其面积为前臂皮瓣供区缺损的80%。小叶用于修复大叶,其面积为大叶的50%。结果：全部13例前臂皮瓣成活,无皮瓣坏死,头颈部缺损均获得I期关闭和愈合。前臂供区均采用I期临近双叶瓣修复,两例患者出现瘀斑和水泡,经处理后均未影响双叶皮瓣的存活。所有患者前臂肘关节及腕关节运动正常,无受限。结论：改良的供区不植皮的前臂皮瓣制备技术减少了术后和供区并发症的发生,临近双叶皮瓣的运用避免了植皮带来的外形及功能影响,值得在头颈肿瘤前臂皮瓣修复中应用推广。     

股前外侧皮瓣修复口底癌术后缺损

目的:评价股前外侧皮瓣在口底癌术后缺损修复中的应用价值.方法: 2005年3月至2007年6月,应用吻合血管的股前外侧皮瓣一期修复口底癌术后缺损10例.皮瓣大小为12cm×5cm至6cm×4cm.结果:10例皮瓣全部成活,外观满意.口腔功能基本恢复.随访2月到26个月,10例患者均健在.其中1例于术后6个月局部复发,再次行局部扩大切除及股前外侧皮瓣修复.结论: 吻合血管的股前外侧皮瓣血管蒂长,血管口径大,供瓣区隐蔽.是一种适合口底缺损修复的游离皮瓣.     

口底鳞状细胞癌术后缺损修复方法分析

目的探讨口底鳞状细胞癌术后缺损的修复方法和效果。方法回顾性分析中国医学科学院肿瘤医院1991年1月至2010年12月治疗的69例口底鳞状细胞癌患者的修复方法和效果。结果 69例患者中,采用修复局部或区域皮瓣30例,游离皮瓣20例,游离植皮9例,未修复10例。局部或区域皮瓣部分坏死2例,完全坏死3例,游离皮瓣无坏死。手术后发生口底瘘10例(14.5%),与口底瘘明显相关的因素有皮瓣坏死,用局部或区域皮瓣有较高的口底瘘发生率。结论口底鳞癌手术后缺损时应选用可靠的修复方法,修复失败后口底瘘发生率明显升高,建议多选用游离皮瓣以降低并发症的发生。     

应用游离股前外侧皮瓣修复头颈部软组织缺损

背景与目的：股前外侧皮瓣（ALT）对供区创伤小,有独特优点,但目前临床应用还不常见。本文探讨应用ALT皮瓣修复头颈部软组织缺损的临床价值。方法：回顾2004年11月至2008年5月期间于中山大学肿瘤医治中心20例应用ALT皮瓣修复重建头颈部软组织缺损的病例资料。总结皮瓣切取的技术细节。报告术中解剖和成功率。结果：20例游离股前外侧皮瓣修复头颈部软组织缺损均获成功。ALT皮瓣血管蒂长介于5～14cm,平均9．9cm。切取的面积介于（4～9cm）×（6～16cm）。皮肤穿支的解剖类型分为肌间隔穿支4例（占20％）,肌皮穿支16例（占80％）。股前外侧皮瓣用于修复的头颈部缺损包括口腔内黏膜缺损14例（其中修复舌体及口底9例、口颊黏膜3例、硬腭1例、以及磨牙后区黏膜1例）．面部及颈部皮肤缺损6例。皮瓣供区除1例以外均可一期缝合。结论：股前外侧皮瓣是头颈部各种软组织缺损修复重建中一个很有价值和应用潜力的供区,具有成功率高,对供区影响小的特点。     

全腹外斜肌筋膜皮瓣下移修复肿瘤性腹股沟和下腹壁缺损

目的:介绍一种简单、安全有效的覆盖肿瘤切除后,腹股沟和下腹壁区缺损修复的新方法.方法:2005年9月～2007年12月,治疗4例患者.其中恶性纤维组织细胞瘤1例,纤维肉瘤1例,血管肉瘤1例,阴茎癌腹股沟淋巴结转移1例,全部病例均为多次手术后复发.切口起于腹股沟和下腹壁缺损区的内上角,沿中线走行至剑突后转向外上方,经由乳晕下方至腋后线.切开腹直肌前鞘的内缘,向外侧掀起腹直肌前鞘和续接的全腹外斜肌及其表面皮肤,形成具有宽大蒂部的肌筋膜皮瓣.然后,将皮瓣下移,覆盖在腹股沟和下腹壁缺损区.裸露的供区,利用皮肤和皮下组织的弹性,直接缝合.切除的范围从18×15～22×18cm,平均310cm<'2>.转位的肌筋膜皮瓣从30×17～37×20cm,肌筋膜皮瓣平均下移11cm以上.所有的创面均一期闭合,仅1例3×3cm区游离植皮.结果:4例转位的肌筋膜皮瓣全部成活,其中3例所有切口均一期愈合,1例下缘裂开,经换药愈合.平均随访11个月,复发1例.无腹壁疝出现.结论:应用全腹外斜肌筋膜皮瓣修复腹股沟区和下腹壁缺损,是一种简单,安全和有效的新方法.     

颏下岛状皮瓣修复面部皮肤癌术后缺损

目的探讨颏下岛状皮瓣修复面部皮肤癌术后缺损的临床效果。方法 2009年1月至2012年12月,收治面部皮肤癌患者13例,肿瘤扩大切除后面部遗留缺损范围为5.0 cm×4.5 cm~12.0 cm×10.0 cm,以颏下动静脉为血管蒂,制成颏下岛状皮瓣,最大面积为13.0 cm×9.0 cm,最小面积为5.5 cm×5.0cm,修复肿瘤扩大切除的面部大范围缺损。结果 12例皮瓣一期愈合,有1例皮瓣局部裂开,延期愈合。随访12~18个月,所有患者均无肿瘤复发,皮瓣全部成活,供区瘢痕不明显,受区外观及功能良好。结论颏下岛状皮瓣具有血供稳定充足,可供面积大,弹性及颜色与面部组织接近,成活率高等优点,是修复面部皮肤癌术后大范围缺损的理想选择。     

颈阔肌肌皮瓣修复口底组织缺损的临床研究

目的:研究颈阔肌肌皮瓣在口底恶性肿瘤切除术后口底组织缺损即刻修复中的应用价值。方法:对9例口底恶性肿瘤切除后遗留的口底组织缺损行颈阔肌肌皮瓣修复,其中6例口底鳞癌患者修复与颈淋巴清除术同期进行,1例同时行下颌骨矩形方块切除,3例为舌下腺腺样囊性癌患者行口底局部扩大切除术。结果:9例颈阔肌肌皮瓣全部成活;3例在肌皮瓣尖端与舌腹部黏膜组织间出现裂开,长2.0～3.0cm,给予清创重新缝合后愈合;3例皮瓣远端少许淤血,未影响愈合。术后6个月复查,所有患者皮瓣收缩不明显,所修复的口底形态及舌体活动功能良好。结论:颈阔肌肌皮瓣血供丰富、解剖恒定可靠、邻近口腔、制作方便、简单快捷和成功率高,是修复口底组织缺损的一种安全选择。     

组织皮瓣移植在口腔及颌面部恶性肿瘤术后修复中的应用

从1986年3月～1995年5月,头颈外科应用前臂游离皮瓣及岛状胸大肌肌皮瓣修复口腔及颌面部恶性肿瘤大面积切除后组织缺损50例(52次手术)。男性36例,女性14例。鳞状细胞癌43例,腺癌7例,前臂游离皮瓣重建舌5例,颊粘膜3例,腮腺癌切除后皮肤缺损4例,岛状胸大肌肌皮瓣修复口底及舌15例,牙龈4例,扁桃体癌术后3例,眼睑癌侵及眶内切除1例。50例中47例成功占94％,其中三年生存率62.9％(22/35),五年生存率36.4％(8/22)。     

头颈部恶性肿瘤术后缺损的Ⅰ期修复与重建

目的：探讨不同修复方法在头颈部恶性肿瘤术后缺损Ⅰ期修复与重建中的作用。评价其临床效果。方法：1989年1月至1998年12月，我们对258例头颈部恶性肿瘤患者的术后缺损进行了Ⅰ期修复与重建，患者年龄23-81岁，中位年龄51.3岁，男160例，女98例，缺损部位包括；头皮62例，颈部40例，口颊部39例，鼻部29例，唇颏部27例，颧颞部22例，下颌骨20例舌及口底部12例，其它7例，修复方法：局部皮瓣修复75例；局部皮瓣加游离植皮53例，邻近组织瓣修复加游离植皮47例，肌皮瓣18例，肌皮瓣加局部皮瓣或游离植皮25例；游离组织瓣移植30例，游离组织瓣加邻近组织瓣修复3例；组织代用品7例。结果：全组258例病人，共采用276个皮瓣及组织代用品修复，手术成功224例，手术基本成功23例，手术失败11例。结论：头颈部肿瘤术后Ⅰ期修复与重建可最大限度地减少术后功能障碍和畸形，提高患者生存质量。     

肌腱悬吊联合前臂皮瓣重建口腔癌术后合并口角缺损的临床应用研究

目的：探讨肌腱悬吊联合前臂皮瓣游离移植修复重建口腔癌术后合并口角缺损的临床效果。方法：对12例颊粘膜鳞癌根治术后合并口角缺损的患者,根据唇、颊部和口角缺损大小个性化设计前臂皮瓣,供、受区血管行端端吻合,按缺损长度切取掌长肌肌腱与口轮匝肌和颊肌悬吊缝合重建口角。结果12例血管化游离移植前臂皮瓣全部存活,术后口角外形满意。术后随访6~24个月,所有患者唇颊部形态、功能恢复良好,无明显言语及咀嚼功能障碍,未见肿瘤复发及远处转移。结论：肌腱悬吊联合前臂皮瓣游离移植是修复口腔癌术后合并口角缺损较为理想的一种选择。     

Comparison of radial forearm free flap, pedicled buccal fat pad flap and split-thickness skin graft in reconstruction of buccal mucosal defect

There are a variety of methods to reconstruct the mucosal defect after the ablation of buccal cancer. We used the radial forearm free flap (RFFF), pedicled buccal fat pad flap (PBFPF) or split-thickness skin graft (STSG) to reconstruct the buccal mucosal defect in our series respectively and compared the mouth-open width among these methods. We found there was no significant difference in the change of mouth-open width between the Group STSG and Group PBFPF. However, the negative effect on the mouth opening was significantly less (p<0.05) in Group RFFF when compared with the Group STSG or Group PBFPF. In conclusion, reconstruction with radial forearm free flap for buccal mucosal defect carries more chances to preserve the original mouth-open width than with pedicled buccal fat pad flap or split-thickness skin graft among the selected patients who undergo tumor resection for T2 or T3 buccal cancer.     

股前外侧皮瓣在外阴肿瘤术后的修复应用

目的：评价股前外侧皮瓣在外阴肿瘤术后缺损修复中的应用价值。方法：应用带旋股外侧动脉降支和股前外侧皮神经为蒂的股前外侧皮瓣一期修复外阴肿瘤术后缺损１０例,皮瓣大小为１０ｃｍ×１４ｃｍ～１４ｃｍ×２０ｃｍ。结果：１０例皮瓣全部成活,随访２～１２个月,外观满意,皮瓣感觉功能存在,局部肿瘤无复发。结论：股前外侧皮瓣血管蒂长,血管口径大,供瓣区隐蔽。带感觉神经的股前外侧皮瓣是一种适合外阴肿瘤术后缺损修复的理想皮瓣。     

腔镜辅助切取背阔肌肌瓣在乳腺癌保留乳房手术中的应用

目的探讨乳腺癌保留乳房手术后即刻在腔镜辅助下经腋窝小切口行背阔肌肌瓣转移整形的临床应用。方法2008年1月至2009年7月,本科对10例年龄为30～52岁（平均36岁）的原发性乳腺癌患者进行了病灶局部扩大切除后即刻在腔镜辅助下经腋窝小切口切取背阔肌肌瓣转移整形。然后对肿瘤的特性、切除腺体标本的质量、切缘状况、切取背阔肌的切口长度、背阔肌肌瓣大小、切取背阔肌的时间、美容效果和术后并发症进行评估。结果肿瘤直径为2～5cm（平均3cm）,标本质量为110～215g（平均150g）,阴性切缘距肿瘤边缘的距离为1～2cm（平均1．5cm）,切取背阔肌的切口长度10～14cm（平均12cm）,背阔肌肌瓣大小为6cm×12cm～8cm×15cm、切取背阔肌的时间为1～2h。术后3个月美容效果优3例,良好6例,尚可l例,无外形差的病例。术后所有患者对乳房形态均满意,无严重并发症发生。结论利用腔镜辅助切取背阔肌肌瓣即刻修补乳房缺损,既可缩小手术疤痕,又可减轻手术创伤,是改善保留乳房手术后乳房美容效果的一个好方法。     

Clinical applications of free medial tibial flap with posterior tibial artery for head and neck reconstruction after tumor resection

Tumor resection causes damage in the head and neck which creates problems in swallowing,chewing,articulation,and vision,all of which seriously affect patients' quality of life.In this work,we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection.We discussed the anatomy,surgical technique,and the advantages and disadvantages of the flap.We found several benefits for the flap,such as,it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect;a two-team approach can be used because the donor site is far away from the head and neck;and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft.Thus,the medial tibial flap could replace the forearm flap for certain applications.     

舌癌224例根治性手术后立即整复

本文报告我科1978年1月～1987年12月10年间224例舌癌联合根治术后应用各类组织瓣一期重建缺损的治疗经验。移植234块组织瓣的总成功率为94.0％。作者指出:游离前壁皮瓣手术简单,成功率高,是理想的半舌切除后舌再造的首选皮瓣。胸大肌肌皮瓣或背阔肌肌皮瓣能提供丰厚的组织,适用于全舌、全口底切除后的整复。肋骨背阔肌或肋骨胸大肌肌皮瓣则适用于全舌、口底和下领骨联合根治性切除术后缺损的立即整复。     

Metastatic spread of floor of the mouth squamous cell carcinoma via pectoralis major myocutaneous flap

In a patient with recurrent head and neck squamous cell carcinoma, reconstruction of the floor of the mouth was carried out by transposition of a pectoralis major myocutaneous flap after composite resection. Twelve months after surgery, a chest wall metastasis corresponding to the site of the vascular pedicle was observed. It appears that the lymphatic and hematogenous tumor spread can occur along the vascular pathways of a transposed myocutaneous flap.     

Comparison of deltopectoralis flap and free radial forearm flap in reconstruction after oral cancer ablation

Defects in the head and neck resulting from ablation of oral cancer frequently lead to disabling functional and cosmetic deformities. Rehabilitation of patients with oral cancer can be an emotionally and technically challenging endeavor. Selection of the donor tissue is clearly dependent upon the defect that is to be reconstructed. The donor tissue should be of sufficient bulk and pliability to facilitate reestablishing contour and function. Regional flap and free flap have been the mainstays of reconstruction for surgical defects after ablation of oral cancer. The records of 77 patients in whom 49 deltopectoral (DP) flaps and 28 free radial forearm flaps (FRFF) were used were analyzed. The success rate of the DP flap was 89.8% and of the FRFF was 96.4%. The minor complication rate at the transplant site (fistula, dehiscence, hematoma) for the DP flaps was 22.4% and for the FRFFs was 14.3%. Overall complication rate at the transplant site for DP flaps was 32.7% and for the FRFFs was 17.9%. The incidence of partial loss of the donor-site skin graft was 4.1% for the DP flaps and 10.7% for the FRFFs. Overall complication rate at the donor site for DP flaps was 10.2% and for the FRFFs was 39.3%. DP flaps had better aesthetic and functional results at the donor site, than FRFFs. However, the DP flap is a staged procedure and results in prolonged hospitalization. In contrast to FRFF, performing a DP flap avoids the difficult technique of microanastomosis, and therefore reduces the donor-site complication rate and the operation time. Therefore, free flaps can not be routinely substituted for regional flaps, but they represent better reconstructive alternatives for specific and selected patients.