Anterolateral thigh myocutaneous flaps as the preferred flaps for reconstruction of oral and maxillofacial defects

BackgroundThe anterolateral thigh myocutaneous flap is one of the most commonly used flaps in reconstructive procedures, but its application in oral and maxillofacial defects has not been fully determined. Herein, we summarize the application of 1212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects and examine their benefits in maxillofacial reconstruction of these defects.MethodsPatients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Patient ages ranged from 6 to 82 years with a mean age of 51.2 years. There are 1015 flaps showing single lobe and 197 flaps showing a multi-island pedicle and one of which carries the iliac bone. The largest area among the single flaps was 28 × 12 cm², and the smallest was 3 × 2 cm².ResultsAmong the 1212 transferred flaps, 1176 survived and 36 showed necrosis, a survival rate of about 97.0%. The common complications at flap donor site were poor wound healing (10.1%), localized paraesthesia (50.1%), and altered quadriceps force (11.0%). No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time (23–121 min; average 51 min) for anastomosis of one vein and one artery was significantly less than that for two veins and one artery (45–153 min, average 83 min; p = 0.0003), which indicates one vein anastomosis can significantly reduce the operating time.ConclusionThe anterolateral thigh myocutaneous flaps can be easily obtained and can provide a good amount of muscle for filling dead space and fascia lata. These flaps can be prepared into a separate fat flap, multi-island fascia with iliac bone, and other composite pedicle flaps to meet the various requirements of oral and maxillofacial defects. The subcutaneous fat thickness of the anterolateral area can vary considerably and thus can be used to repair defects requiring different flap thickness. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.     

舌骨下肌皮瓣在老年口腔癌术后缺损修复中的应用

目的：探讨舌骨下肌皮瓣在老年口腔癌切除术后缺损修复中的应用价值。方法：回顾分析2005年12月—2010年11月间收治的口腔癌患者19例。男11例,女8例;年龄65～89岁,平均72.8岁。舌癌10例,口底癌6例,颊癌2例,下颌牙龈癌1例。均采用舌骨下肌皮瓣修复术后所致软组织缺损。结果：术后切口均一期愈合,19例舌骨下肌皮瓣全部成活,无1例发生全部或部分皮瓣坏死。患者获得满意的外观和功能。经过6个月～5a的随访,无一例肿瘤复发或远处转移。结论：舌骨下肌皮瓣制备较简单,效果可靠,且成活率高,是老年患者口腔癌修复重建的适用方法。     

胸大肌肌皮瓣修复口腔癌术后缺损并发症原因分析

目的:分析胸大肌肌皮瓣修复口腔癌术后缺损出现并发症的原因。方法:对40例晚期口腔癌患者行扩大根治术后采用胸大肌肌皮瓣修复口内组织缺损,对出现并发症的原因进行总结分析。结果:1例皮瓣部分坏死(2.5%),2例术后伤口裂开形成颏下瘘管(5%),2例颈部伤口感染(5%)。结论:细致的手术操作,术中充分止血,术后通畅的引流及口腔护理可有效避免并发症的发生,提高胸大肌肌皮瓣的移植成活率。     

舌骨下肌皮瓣修复口腔颌面部缺损

近年来,随着显微外科技术的发展,越来越多的游离皮瓣被应用到口腔颌面部缺损的修复中去,甚至在很多单位游离皮瓣已经成为口腔颌面外科医生的第一选择.但是,并不是所有的患者都适合选择游离皮瓣,也不是所有的缺损都必须选择游离皮瓣才能获得良好的修复效果,因此,作为一名优秀的口腔颌面外科医生、头颈外科医生和修复重建医生必须掌握包括各种皮瓣在内的多种修复手段,并且能够在不同的情况下正确地选择不同的修复方法.舌骨下肌皮瓣被发现至今已逾30多年,是已经被时间所证明的优秀的皮瓣之一,它的皮肤颜色良好、厚度及组织量适宜、瘢痕较小、并发症少见,几乎可以修复咽、舌、口底的全部缺损.然而,关于舌骨下肌皮瓣的报道及经验交流最近却相对较少,本文旨在结合笔者的临床经验对舌骨下肌皮瓣的制取进行论述,希望能够对广大的口腔颌面外科医生、头颈外科医生和修复重建医生有益.     

Reconstruction of through-and-through oral cavity defects with folded extended vertical lower trapezius island myocutaneous flap

Reconstruction of through-and-through defects of the head and neck is a challenge. In this clinical study we assessed the feasibility of the folded, extended, vertical, lower trapezius island myocutaneous flap (TIMF) for the reconstruction of 16 large through-and-through defects of the oral cavity, which were reconstructed after resection of oral cancer. The skin paddle was 5–7 cm wide and 11–20 cm long. The folded flap provides both inner and outer linings for through-and-through defects, and all the flaps survived. The appearance of the head and neck was acceptable, and oral function was satisfactory. The folded extended vertical lower TIMF is a large, simple, and reliable flap that is preferred for the reconstruction of large through-and-through defects after resection of oral carcinoma.     

游离组织辦在口腔颌面-头颈肿瘤缺损修复中的应用:2549例临床分析

目的:探讨不同游离组织瓣在口腔颌面-头颈肿瘤缺损与修复中的应用价值。方法:回顾分析1979年1月～2006年12月间,我院口腔颌面外科所行血管化游离组织瓣移植患者2549例,共制备皮瓣2684块:软组织瓣包括前臂皮瓣、背阔肌皮瓣、胸大肌皮瓣、股前外侧皮瓣、肩胛皮瓣等;骨组织瓣包括腓骨肌皮瓣、髂骨肌皮瓣、肩胛骨肌皮瓣等。分别用于修复舌、腭、颊、口底、颌骨及面颈部大面积复合缺损。统计各年代游离组织瓣移植的成功率,分析失败原因。结果:游离组织瓣移植成功率从80年代初期(92%)至今(98.5%),呈逐年升高趋势,2684块皮瓣总成功率达96.80%。前臂皮瓣是最常用的游离组织瓣(64.12%),胸大肌皮瓣和背阔肌皮瓣在修复大面积复合缺损常被采用,各种骨肌(皮)瓣应用于颌骨缺损修复成为近年的热点。大范围复合组织缺损的救治性手术常需要多个游离组织瓣联合修复重建。结论:血管化游离组织瓣移植是口腔颌面-头颈肿瘤手术根治的保障,更是术后缺损修复的主要手段。前臂皮瓣是修复舌、颊、腭等软组织缺损的首选瓣,胸大肌与背阔肌(皮)瓣适合修复体积较大的缺损,腓骨、髂骨肌瓣是上、下颌骨缺损最常用的修复手段。其他不常用的组织瓣,应根据不同适应证进行选择。采用不同组织瓣修复口腔颌面部缺损,对患者术后外形及功能具有重要意义。     

The sub-fascial pattern of the myocutaneous platysma flap – The anatomical basis and preliminary cases for oral reconstruction.

To verify the feasibility of the SF-MPF for oral reconstruction, the anatomic, sonographic and histologic features of the SF-MPF were investigated and the outcome in a series of patients was evaluated.The sonographic and histologic results showed a supra-fascial arterio-venous vascular blood supply to the sub-fascial design of the MPF. The clinical course of 12 consecutive patients who underwent oral reconstruction using the SF-MPF along with ipsi- or lateral neck dissection for treatment of oral cancer showed sufficient pedicle length and reliable blood supply.The SF-MPF is a reliable and safe pedicled myocutaneous flap. Therefore, it should be considered being an additional option when a pedicled flap has to be selected.     

舌骨下肌皮瓣修复口腔颌面部软组织缺损

目的 探讨舌骨下肌皮瓣修复口腔颌面部软组织缺损的特点.方法 2001年12月～2006年11月住院的口腔癌初诊患者10例,均经病理确诊.其中男8例,女2例,年龄31～60岁,平均47岁,中位年龄50岁.舌癌1例, 颊癌2例, 口底癌4例,牙龈癌3例.均采用舌骨下肌皮瓣修复术后所致软组织缺损.供区皮肤直接拉拢缝合,无继发畸形.结果 术后切口均Ⅰ期愈合,10例舌骨下肌皮瓣全部成活,无1例发生全部或部分皮瓣坏死,移植成活率100%.患者获得满意的外观和功能.经过6个月～5年的随访,无一例肿瘤复发或远处转移.结论 舌骨下肌皮瓣制备较简单,效果可靠,且成活率高.可用于口腔颌面部软组织缺损的修复.     

逆行面动脉瓣修复口腔颌面部肿瘤术后缺损12例报道

目的:探讨逆行面动脉瓣修复口腔颌面部肿瘤缺损的效果。方法:选择2008年5月—2011年1月在中山大学孙逸仙纪念医院口腔科就诊的发生于上颌、软腭、颊部等口裂以上的12例肿瘤患者,肿瘤根治术同期采用逆行面动脉瓣修复组织缺损。结果:12例患者中,皮瓣成活11例(91.7%),完全坏死1例。术后随访8～36个月,局部、颈部肿瘤复发各1例。下颌下区切口均一期愈合,无裂开。2例患者术后出现面神经损伤。结论:逆行面动脉瓣制备简单,血供可靠,适合修复口腔颌面部口裂以上的缺损。     

舌瓣重建口腔软组织缺损研究进展

尽管目前口腔内软组织缺损越来越多地采用游离皮瓣修复,舌瓣如使用得当,仍不失为一种安全可靠且并发症少的修复方法,尤其适用于腭、磨牙后区、后颊、下唇唇红及舌部分切除后中等大小的软组织缺损。本文就舌瓣的解剖学基础及其在口腔内软组织缺损中的临床应用进展作一综述。     

前臂皮瓣与股前外侧皮瓣修复口腔颌面部缺损的效果比较

目的 比较分析前臂皮瓣和股前外侧皮瓣修复重建口腔颌面部肿瘤术后缺损的临床效果。方法 收集 54例行口腔颌面部恶性肿瘤根除术并接受游离皮瓣修复术的患者资料,其中33例患者采用前臂皮瓣修复（A组）、21例采用股前外侧皮瓣修复（B组）。应用SPSS 19.0软件包分析2组患者的手术持续时间、皮瓣存活率、受区功能与外形恢复情况、供区恢复情况及患者满意度等。结果 A组手术时间为（41.6±8.9）min,B组为（47.2±10.2）min,差异具有统计学意义（P<0.05）;A组皮瓣存活率（93.9%）高于B组（90.5%）,但差异无显著性（P>0.05）;受区功能与外形恢复情况2组基本相似;供区功能恢复B组优于A组,A组永久性功能障碍比率为24.2%,B组仅有暂时性功能障碍且比率为9.5%;A组供区色素沉着发生率显著高于B组（P<0.05）;B组的满意度显著优于A组（P<0.05）。结论 应用前臂皮瓣与股前外侧皮瓣修复,术后受区功能、外形恢复情况相似。前臂皮瓣成功率高,但需要植皮,且术后供区易形成永久性功能障碍;股前外侧皮瓣供区隐蔽,可以提供的组织量大,术后供区功能障碍很少,患者满意度高,但是手术难度大于前臂皮瓣,技术要求高。     

面动脉-颏下动脉肌皮瓣在口腔颌面部软组织缺损修复中的应用

目的探讨面动脉-颏下动脉肌皮瓣在口腔颌面部缺损修复中的应用。方法应用面动脉一颏下动脉肌皮瓣修复口腔颌面部软组织缺损病例12例,皮瓣面积最小为5cm×4cm,最大为12cm×6cm。术后随访．观察皮瓣的成活情况、外形和功能、癌肿复发以及患者的生存状况。结果12例皮瓣均成活,术后6个月,所有患者受区形态及功能恢复良好,无明显的颈部活动受限。随访1—5年,均未出现颏下及颌下区淋巴转移及皮瓣内癌肿的复发。结论面动脉一颏下动脉肌皮瓣制备较简易,成活率高,在口腔癌术后缺损中具有较好的修复效果。     

Early oral intake after reconstruction with a free flap for cancer of the oral cavity

To allow healing of the surgical wound patients are traditionally given nothing by mouth for 6–12 days after resection and reconstruction of a cancer of the oral cavity. Our aim was to assess the impact of introducing oral intake within 6 days postoperatively. Consecutive patients who had resection and reconstruction of a cancer of the oral cavity with a free flap within an 8-year period were selected from the head and neck database. Personal and social data; type, stage, and site of the tumour; type of resection and free flap; postoperative complications; and duration of hospital stay were recorded, supplemented by review of casenotes for the time that oral intake was started, duration of nasogastric and tracheostomy intubation, and changes in body weight. Patients in the early oral intake group started oral intake within 5 days postoperatively, and those in the late group began feeding from postoperative day 6. The duration of hospital stay in the early group was significantly shorter than that in the late group. There was, however, no difference in the morbidity, including orocutaneous fistula, between the two groups. The duration of nasogastric and tracheostomy intubation was shorter, and weight loss was less, in the early group than in the late group, but not significantly so. Early oral feeding does not increase the morbidity for patients having resection and reconstruction with free flaps for cancers of the oral cavity. Early oral intake is associated with a shorter hospital stay, and this may have implications for improved postoperative outcome.     

斜方肌骨肌皮瓣在修复半侧下颌骨切除及口腔软组织缺损中的应用

目的：评价斜方肌骨肌皮瓣修复口腔软组织和半侧下颌骨切除术后缺损的可靠性。方法：10例口腔、颌骨恶性肿瘤患者行半侧下颌骨和累及的软组织手术切除，术后缺损采用斜方肌骨肌皮瓣修复。男6例，女4例，年龄45～79岁，平均年龄61．2岁。T4N0M0期3例，T4N1M0期7例。皮瓣大小为（7cm×6cm）～（16cm×8cm）。结果：8例患者皮瓣全部成活。2例患者皮瓣边缘略有坏死。随访观察7～24个月，7例患者生存良好，无复发；1例患者死于肝、肺转移；2例患者术后复发，行二次手术，目前尚存活。结论：斜方肌骨肌皮瓣是一种修复口腔软组织和下颌骨半侧切除遗留的巨大缺损可靠的方法。     

面动脉瓣修复口咽癌术后缺损

目的探讨面动脉瓣修复口咽癌术后缺损的效果及临床应用。 方法选择2008年5月至2014年1月中山大学孙逸仙纪念医院口腔颌面外科收治的口咽癌患者33例,行肿瘤扩大切除术同期采用顺行或逆行面动脉瓣修复组织缺损。 结果33例面动脉瓣中,逆行性皮瓣11例全部成活,而顺行性皮瓣成活18例、部分坏死2例、完全坏死2例。皮瓣成活病例伤口愈合良好,患者术后语音和吞咽功能得到恢复。 结论应用面动脉岛状肌皮瓣修复口咽癌切除术后缺损,制取技术简单,皮瓣血供明确,皮瓣成活率高,瘢痕较为隐蔽,是修复口咽癌切除术后缺损的理想皮瓣。     

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.     

横向颈阔肌肌皮瓣和面动脉-颏下动脉岛状肌皮瓣修复颊黏膜癌术后缺损

目的：评价横向颈阔肌肌皮瓣和面动脉-颏下动脉岛状肌皮瓣修复颊黏膜癌术后缺损的可靠性。方法：27例颊黏膜鳞状细胞癌手术切除后组织缺损，用颈阔肌肌皮瓣修复15例，面动脉-颏下动脉岛状肌皮瓣修复12例。男19例，女8例；年龄38～74岁，平均56．4岁；T1NOM0期6例，T2N0M0期19例，T3N0M0期2例。皮瓣大小为4．0cm×8．0cm。5．0cm×11．0cm。结果：颈阔肌肌皮瓣存活13例，3例小部分坏死，成功率为86．7％（13／15），面动脉-颏下动脉岛状肌皮瓣成功率为91．7％（11／12）。全部病例经6—24个月复查，受区功能正常，供区外形良好。局部复发1例，颈部复发2例。结论：颈阔肌肌皮瓣和面动脉-颏下动脉岛状肌皮瓣均适于颊黏膜中、小型缺损修复。面动脉-颏下动脉岛状肌皮瓣可能比颈阔肌肌皮瓣更为可靠。     

延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损

颈横动脉供血的延长垂直下斜方肌岛状肌皮瓣(extended vertical lower trapezius island myocutaneous flap,eVLTIMF)用于修复重建大型头颈部缺损安全可靠。该瓣制备较简单,成活率高。供区较隐蔽,可直接关闭缝合,并发症少,肩部运动受影响较小;还可制备成折叠瓣,合并其他带蒂瓣或合并肩胛骨骨肌皮瓣修复特大洞穿性缺损或下颌骨缺损。eVLTIMF在头颈部大面积缺损修复,尤其是在晚期复发性头颈部肿瘤挽救手术后巨大缺损修复重建中起着重要作用。本文对斜方肌的临床应用解剖、 eVLTIMF瓣制备及其在颅颌面、口腔颌面和颌颈区缺损修复中的应用作一阐述。     

胸外侧切口锁骨下隧道胸大肌肌筋膜瓣在口腔修复中的应用

目的:采用胸外侧切口锁骨下隧道的胸大肌肌筋膜瓣修复口腔缺损,扩大传统胸大肌肌皮瓣的使用范围。方法:在传统胸大肌肌皮瓣基础上,将胸前壁切口改为胸外侧以增加美观;使用胸大肌及其筋膜替代皮肤,以减轻组织瓣的臃肿,改善血运,避免破坏女性乳房功能和外观;应用锁骨下隧道增加筋膜瓣的旋转半径,并对胸大肌肌筋膜瓣的血供特点、上皮化过程及锁骨下隧道的安全性进行临床观察。结果:肌筋膜瓣27例,26例成活,总成活率96％(26/27)。12例发生不同并发症,占44％(12／27),主要为筋膜瓣部分坏死脱落(5例)和口咽颈部瘘管(3例)。其中4例需局部手术处理(15％),无与锁骨下隧道直接有关的并发症。所使用方法可增加旋转半径5-8cm。筋膜上皮化在术后4周左右完成。结论:所介绍方法可明显增加组织瓣的旋转半径,有效地保存乳房的形态和功能,并使瘢痕位于相对隐蔽位置。该方法可有效扩大传统胸大肌肌皮瓣的使用范围。