扁桃体癌手术及修复方法的选择

目的 探讨扁桃体癌手术切除入路与组织缺损的几种修复方法及疗效.方法 采用颈前舌骨入路及下颔骨正中裂开外旋入路切除19例扁桃体癌,分别应用舌瓣、颞肌筋膜瓣及胸大肌肌皮瓣修复缺损.结果 1例胸大肌肌皮瓣术后出现皮肤部分坏死,3例颞肌筋膜瓣修复者术后张口轻度受限,其余患者术后呼吸、吞咽、咀嚼和语音功能恢复良好.结论 在选择合适的手术入路彻底切除肿瘤的前题下,熟练地掌握多种修复方法,择优采用,是恢复良好口咽功能,提高患者术后生活质量的重要保证.     

Reconstruction of two mandible defects with one fibular flap

The present report describes an original surgical procedure for the mandibular reconstruction of 2 different defects using a single fibular flap. In addition to the habitual osteotomies, we resected a bone fragment from the middle portion of the flap, with care taken to maintain the integrity of the pedicle throughout its extension to guarantee an adequate blood supply also for the distal portion of the bone flap used for the treatment of the smaller mandibular defect. This simple maneuver permitted the reconstruction of 2 mandibular regions with well-vascularized bone tissue using a single microsurgical flap.     

Reconstruction of nasal defects with a nasolabial island flap

The superiorly based nasolabial island flap is a versatile method for reconstructing lower, mid, and upper nasal defects. Our technique and successful experience in eight consecutive cases are presented. Cadaver injection studies were performed and demonstrated the important contribution of the infraorbital artery to the blood supply of this flap.     

Reconstruction of hypopharyngeal defects with submental flap after laryngopharyngectomy

The submental flap has rekindled interest in using cervical flaps for reconstruction of head and neck defects. In this article, the authors present their experience of using this flap for hypopharyngeal defects after laryngopharyngectomy. This is a retrospective study of six patients who underwent hypopharyngeal defect reconstruction with submental flap from 2008 to 2011, operated upon by a single surgeon (JC Lee). The flap was used primarily to reconstruct defects after tumor extirpation. The maximum flap size was 12 × 7 cm and the minimum size was 9 × 4 cm (average, 10.5  × 5.3 cm). No flap failures were observed. All the donor site defects were closed primarily. Two patients developed a small pharyngocutaneous fistula that resolved spontaneously. No other complications were observed. After speech reeducation, all achieved a good-quality, understandable artificial voice. All patients were able to eat by mouth without the need for tube feeding. The submental flap is an excellent alternative in the reconstruction of hypopharyngeal defects because of its reliability, versatility, pliability, and relative ease of application. Our initial reports confirm that this kind of reconstruction is feasible and time-saving, and restored a good quality of life.     

Reconstruction of intraoral defects with the free groin flap.

A free flap has been defined as an island flap that has been completely detached from the body and transferred to a distant recipient site, where microvascular anastomoses are done to reestablish its essential intravascular circulation. The groin flap, based on its superficial circumflex iliac artery and venae comitantes, was utilized as a free flap to close large intraoral defects in six patients following ablative cancer operations. All patients received preoperative or postoperative irradiation therapy. Four of the six free groin flap operations were clinically successful. One flap became necrotic unexpectedly after 3 1/2 weeks. Infection played a major part in necrosis of the other flap. The use of the free flap in oral cavity reconstruction offers certain advantages over regional vascular flaps but definite limitations exist.     

Velopharyngeal function after microsurgical reconstruction of lateral and superior oropharyngeal defects

OBJECTIVES/HYPOTHESIS: Defects of the lateral and superior oropharyngeal wall are difficult to reconstruct because of their complicated anatomy and the possibility of causing velopharyngeal incompetence. The objective was to investigate problems of reconstruction and postoperative velopharyngeal function. STUDY DESIGN: Defects were classified into three types (I, II, and III) according to their extent. Four operative procedures were performed: the Patch, Jump, Denude, and Gehanno methods, which include a lateral-posterior pharyngeal advancement flap. Speech intelligibility, velopharyngeal function, and wound dehiscence between the flap and the remaining soft palate were evaluated. METHODS: Forty patients who had undergone resection of the lateral and superior oropharyngeal walls and subsequent reconstruction were reviewed. RESULTS: Most patients with type I or II defects had satisfactory velopharyngeal function. However, in patients with type III defects, speech function was worse and severe velopharyngeal incompetence was more common. The type of defect and the presence of wound dehiscence were related to postoperative function. The rates of wound dehiscence were lower with the Patch and Gehanno methods. CONCLUSIONS: Postoperative function in patients with type III defects can be affected by various factors. We suggest that the Gehanno method be the treatment of choice for reconstruction of extensive defects of the oropharynx. However, patients in whom more than two-thirds of the superior and posterior oropharyngeal walls has been resected are poor candidates for reconstruction because of the difficulty of maintaining both nasal airway patency and velopharyngeal function.     

上臂外侧皮瓣和前臂皮瓣修复口腔癌术后组织缺损的比较研究

目的 比较上臂外侧皮瓣和前臂皮瓣修复口腔癌术后组织缺损的临床应用效果.方法 对北京大学口腔医院口腔颌面外科2007-2009年收治的21例采用上臂外侧皮瓣和104例采用前臂皮瓣行口腔癌术后缺损修复的患者进行对比研究,比较两种皮瓣的手术制备时间、皮瓣移植成功率、供区并发症及术后口腔功能恢复情况.结果 上臂外侧皮瓣和前臂皮瓣制备的平均手术时间((x)±s)为(46.4±7.6)min和(41.5±7.5) min,差异无统计学意义(P＞0.05).上臂外侧皮瓣和前臂皮瓣的移植成功率分别为90.5％( 19/21)和95.2％ (99/104),差异无统计学意义(P＞0.05).上臂外侧皮瓣供区可直接拉拢缝合,2例患者术后出现桡神经损伤症状;前臂皮瓣患者无供区并发症发生,但供区需行全厚皮片移植,于经常外露的前臂区域遗留手术瘢痕.两种皮瓣患者术后均能经口腔进软食或普通饮食,无发音不清.结论 上臂外侧皮瓣供区隐蔽,无需植皮,移植成功率高,可作为前臂皮瓣的补充,进一步丰富了口腔癌组织缺损的修复手段.     

Reconstruction of intermediate sized mucosal defects with the pectoralis major myofascial flap

An uncovered pectoralis major muscle flap (PMF) was utilized in 12 patients for reconstruction of mucosal defects of intermediate size. The PMF is nonhair-bearing and thinner and more flexible than the myocutaneous flap. Epithelialization of the PMF occurs slowly but results in a mucosal surface that is nonkeratinized and closely resembles normal. The paddle of the PMF contracts as much as 75% during healing. However, none of our patients developed deficits attributable to contracture of the flap, presumably because only modest-sized defects were repaired. The PMF is useful for reconstruction of intermediate-sized defects approximately 6 x 6 cm, defects that are too large to close with local flaps and tend to be too small to be closed conveniently with a bulky myocutaneous flap. Contracture of the PMF precludes its use for reconstruction of large defects.     

Reconstruction of intrathoracic oesophagus using tubular lateral thigh free flap

The gastric pull-up or pharyngogastroplasty is the most widely used technique in reconstructing the digestive tract in cases of distal oesophageal tumours. This operation consists of drawing the stomach or part of it up through the chest and mediastinic region to the neck where a mucosal anastomosis with the residual pharyngeal tract is made. The most feared complication is proximal necrosis of the gastric stump with salivary fistulae usually followed by a mediastinitis. In the presence of such a complication the surgeon must tackle the challenge of reconstructing the missing part of the intrathoracic digestive tract. We describe the case of a patient in whom the missing intrathoracic oesophagus, following complete necrosis of a previously performed pharyngogastroplasty, was reconstructed using a revascularized lateral thigh free flap.     

Reconstruction of nasogenial defects using a triangular nasolabial advancement flap

We describe our preferred method for repairing cutaneous defects after the excision of basal cell carcinoma of the nasogenial region, a triangular subcutaneous pedicle flap. This flap is easily dissected and handled. It is suitable for the repair of defects of the lateral wall of the nose, medial cheek and upper lip.     

Reconstruction of hypopharyngeal defects with anterolateral thigh free flap: A single-center retrospective analysis

IntroductionReconstruction of expanded hypopharyngeal defects following laryngo-hypopharyngectomy for surgical treatment of primary is still a challenge for head and neck surgeons. Tradiotionally, jejunal or radial forearm flaps are the common reconstructive choice. Recently, the anterolateral thigh (ALT) free flap has served for pharyngoesophageal reconstruction. The goal of this work is to describe a retrospective analysis about a five-year single-center experience in the reconstruction of post-operative hypopharyngeal defects with ALT free flap.MethodsA single-center retrospective study was performed, including patients treated for patients who underwent tumor surgery involving hypopharynx with ALT free flap reconstruction from 2015 to 2020. Exclusion criteria were paediatric (0–18 years) patients, and the absence of follow-up.ResultsThe study included 23 adult patients. The mean size of the flap was 90 cm² (range 60–130 cm²). The mean time required to harvest the antero-lateral tight flap was 70 min (range 35–120 min). The median age was 46.3 years (SD 15.81, range: 19–84 years), with a gender female prevalence (F = 48, M = 33). Mean follow-up was 77.7 months (min 4–max 361, SD 72.46). One patient (4.4 %) showed a hypopharyngeal stenosis.ConclusionALT free flap represents a successful and versatile reconstructive option for hypopharyngeal defects extended to oropharynx and/or larynx following total laryngectomy with circumferential or partial hypopharyngectomy, regardless of the functional and aesthetic results, with minimal donor-site complication.     

Free radial forearm flap versus pectoralis major myocutaneous flap reconstruction of oral and oropharyngeal defects: a cost analysis

Objectives: The free radial forearm flap has replaced the pedicled pectoralis major myocutaneous flap and it has become the ‘workhorse flap’ used by many head and neck reconstructive surgeons for soft tissue reconstructions. Cost implications of radial forearm flap reconstruction within the context of the overall health care in a particular system need to be investigated particularly before it is labelled as ‘costly only’. Design and Setting: Forty patients who underwent immediate free radial forearm flap reconstruction for oral or oropharyngeal soft tissue defects were matched with patients who underwent pectoralis major myocutaneous flap reconstruction for similar defects. The 2 years of which the overall management costs according to the hospital perspective were calculated were divided into four periods: operative period, the postoperative phase, follow‐up during first year and follow‐up during second year after discharge. Results: The total costs within the first 2 years were comparable at ∼50 000 euros. The lower costs of hospital admission (24 days versus 28 days; P = 0.005) in the postoperative phase outweighed the higher costs of the surgical procedure (692 min versus 462 min; P < 0.005) in radial forearm flap patients when compared with pectoralis major flap patients. Conclusions: Oral and oropharyngeal reconstruction with radial forearm flap is not more costly than pectoralis major flap reconstruction. Given the better functional outcome and the present cost analysis, reconstruction of oral and oropharyngeal defects is preferably performed using free tissue transfer.     

Buccal fat pad flap for transoral repair of radiation-induced necrosis in the lateral oropharyngeal wall

Soft tissue necrosis (STN) is a late toxicity after radiotherapy. Extensive tissue defects due to STN near the carotid artery, such as in the lateral oropharyngeal wall, may lead to infectious pseudoaneurysms associated with fatal bleeding. Such defects are usually treated with transcervical reconstructive surgeries, which are highly invasive and technically difficult.We report a case in which a buccal fat pad (BFP) flap was used for minimally invasive transoral repair of tissue defects due to radiation-induced STN in the lateral oropharyngeal wall. The BFP flap covered the tissue defect, and the wound epithelialized completely. The patient had no dysfunctional mouth opening, speech, or swallowing.The BFP flap can be easily harvested via a minimally invasive transoral approach and is expected to be further utilized for radiation-induced STN in the lateral oropharyngeal wall.     

Cervicopectoral rotation flap for primary closure of lateral face and neck defects

Objective  To recount our experience with the cervicopecloral flap (clavipfcmral flap, herein after referred to as CVF) fur reconstruction of large lateral cervicofacial defects in fifteen patients, which has been underutilized and has not received due recognition in world literature pertaining to reconstructive surgery. Study Design  Retrospective case review Setting  Tertiary care regional cancer referral center. Patients  Those with lateral cervicofacial defects resulting from extirpative cancer surgical resection. Results  A 100% &#x2018;take rate&#x2019; was observed at the primary defect. In 7% there was full thickness, distal loss that was successfully managed by split thickness skin grafting. Three cases (20%) shaved superficial epidermolysis, which healed by full epithelization within three weeks. Conclusion  This flap provides satisfactory primary closure of surface defects that do not extend beyond an arbitrary line extending from the angle of mouth to tragus and posteriorly beyond the mastoid.     

Reconstruction of large nasal defects with a subcutaneous pedicle nasolabial flap. An underutilized technique

The cosmetic repair and camouflage of large full-thickness defects of the nasal bridge and lower nasal skin can be an arduous task. The standard techniques of split- or full-thickness skin grafts provide for a poor color match and inadequate tissue mass, and other flap techniques do not have the versatility, tissue bulk, and ability to hide the donor site that the subcutaneous nasolabial pedicle flap does. This technique has versatility in treating larger lower nasal bridge defects.     

应用鼻背邻近旋转皮瓣修复外伤性鼻尖部分缺损

自1993年始,应用鼻背部邻近旋转皮瓣修复外伤性鼻尖部分缺损12例。该法修复鼻尖,不但简单易行,而且与受区皮肤颜色相匹配、质地相称,使鼻尖有一定丰满度,同时供区可一期缝合。随访3个月～12个月,外形良好,供区远期疤痕不明显,作者认为此法为目前修复外伤性鼻尖部分缺损最有效的方法之一。     

游离上臂外侧皮瓣修复舌癌术后软组织缺损的临床应用

目的 探讨游离上臂外侧皮瓣一期修复舌癌术后软组织缺损的临床应用。方法 选取2019年6月—2021年9月舌癌根治术的32例患者,应用游离上臂外侧皮瓣同期行舌缺损修复。其中男25例,女7例,病理类型均为鳞状细胞癌。术前多普勒血流探测仪确定上臂外侧区域穿支血管位置,皮瓣轴线位于三角肌止点与肱骨外上髁之间的连线后方1 cm,根据舌缺损面积和形状设计皮瓣。结果 32例患者中,皮瓣大小为7.5 cm×4.0 cm~14.0 cm×6.0 cm,平均厚度为（0.85±0.40） cm,平均血管蒂长度为（8.24±1.37） cm,穿支数量为2~4支。供区切口均一期拉拢缝合。除1例患者术后第4天皮瓣坏死改股前外侧皮瓣修复后皮瓣存活,皮瓣一期成活率为96.9%（31/32）。所有患者术后均未行气管切开。随访7~22个月,平均11个月,患者术后外形及功能恢复较满意,无远期并发症。结论 游离上臂外侧皮瓣血管恒定、制备简单、质地薄软,皮瓣成活率高,供区并发症少,是修复舌癌术后半舌缺损的良好选择。