胸大肌肌皮瓣修复口腔癌术后大面积缺损临床总结

目的:探讨晚期口腔癌术后组织缺损的修复,介绍胸大肌肌皮瓣修复口腔癌术后大面积组织缺损的临床经验。方法:总结分析2005—2009年40例晚期口腔癌患者根治术后胸大肌肌皮瓣修复口内组织缺损的临床资料。结果:40例用胸大肌肌皮瓣关闭口内创面;39例肌皮瓣全部成活;1例部分成活,远端皮肤坏死;术后外形及张口度均恢复良好。结论:胸大肌肌皮瓣组织量大,血运丰富,是修复晚期口腔癌术后大面积组织缺损的一种有效方法。     

围裙式颈阔肌肌皮瓣在口腔颌面部缺损修复中的应用

目的:介绍一种新颖的颈阔肌肌皮瓣术式,评价其修复口腔颌面部缺损的应用价值.方法:用围裙式颈阔肌肌皮瓣修复口腔颌面部病变切除术后缺损的患者15例.设计U形的围裙式切口制备皮瓣,保留蒂部皮肤,加宽肌蒂宽度.结果:15例围裙式颈阔肌肌皮瓣12例完全成活,3例皮瓣部分坏死.其中,修复颊黏膜、舌、牙槽突缺损的皮瓣完全成活率分别为8/9、1/3、3/3.另有2例颈部供区伤口愈合不良.所有病例经4～33个月随访,l例牙龈癌颈部瘢痕较为明显,1例舌癌舌运动受限,其余病例口腔颌面部形态、功能恢复良好.结论:和颈阔肌肌皮瓣比较,围裙式颈阔肌肌皮瓣可提供更宽的皮岛,特别适合中小型颊部软组织及牙槽突缺损的修复,舌部缺损不是该皮瓣最佳适应证.     

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。     

胸大肌肌皮瓣修复口腔癌术后缺损的临床观察

目的:总结用胸大肌肌皮瓣修复口腔癌术后口腔颌面部组织缺损的临床经验。方法:选择舌癌2例、下颌牙龈癌2例及颊癌3例,进行常规联合根治术,同期采用胸大肌肌皮瓣修复术后口腔颌面部组织缺损。结果:7例中6例肌皮瓣全部成活,外形及功能满意;1例肌皮瓣全部坏死,换药后痊愈。结论:胸大肌肌皮瓣同期修复口腔癌术后缺损具有优越性,改良术式更有益于美观。血管变异是导致胸大肌肌皮瓣坏死的原因之一。     

改良式颈阔肌肌皮瓣在口腔内软组织缺损修复中的应用探讨

目的：对比传统的和改良的颈阔肌肌皮瓣手术方法,探讨两种方法的颈阔肌肌皮瓣在修复口腔内软组织缺损中的优缺点和适应症。方法：对18例经过改良的颈阔肌肌皮瓣修复的口腔内软组织缺损患者的术中术后分析,对该皮瓣的适应症和优缺点进行分析,并和传统的手术方法对比。结果：18例病例中痊愈且无并发症者15例,皮瓣尖端坏死1例,口内皮瓣区伤口裂开1例,术后6个月局部肿瘤复发1例。结论：和传统的方法相比较,改良的颈阔肌肌皮瓣增加了供区皮瓣的面积,术后颈部形态好,能够更大范围地修复口内软组织缺损。     

不同皮瓣修复口腔癌术后缺损的效果比较

目的 探讨用横向颈阔肌皮瓣(PMF)与颏下动脉岛状肌皮瓣(SAIF)修复口腔癌术后缺损疗效.方法 选择30例口腔癌术后缺损患者,其中舌癌18例、颊癌9例、腭癌3例.随机分成PMF修复组(15例)和SAIF修复组(15例).观察比较两种肌皮瓣成活率、开口度、面部外形及局部复发情况.追踪观察12 ～ 18个月.结果 30例患者修复后26例Ⅰ期愈合,3例颈阔肌皮瓣术后坏死,成活率为80%;1例SAIF术后出现坏死,成活率为93.3%.术后约1个月皮瓣上皮开始软化,3个月后上皮角质层大部分脱落,约术后1年,接近正常黏膜.30例患者受区功能正常,肿瘤无复发,供区外形良好,开口度正常.2例患者1年后因远处转移而死亡.结论 PMF与SAIF均可以用于修复口腔癌术后中小型缺损,SAIF成活率高于PMF,两者比较有统计学意义(P<0.05).而开口度、面部外形及局部复发情况间差异无统计学意义.     

前臂皮瓣与胸大肌皮瓣在口腔癌手术缺损修复中的应用

目的:观察前臂皮瓣和胸大肌皮瓣修复口腔癌手术缺损的治疗效果。方法:30例口腔癌患者在常规联合根治术后,随机分为A、B组,每组15例。A组采用前臂桡侧皮瓣游离移植同期修复口腔癌术后口腔颌面部缺损,B组采用胸大肌皮瓣同期修复口腔癌术后口腔颌面部组织缺损;对比两组的修复效果。结果:A组13例(86.67%)前臂皮瓣顺利成活,B组皮瓣成活率100%。A组中有6例患者虎口感觉消失、4例患者供区颜色极深或极浅;B组中有4例女性患者术后两侧乳房不对称。结论:前臂皮瓣和胸大肌皮瓣修复口腔癌手术缺损均具有较高的成功率,两种皮瓣均适用于口腔癌手术缺损修复。     

胸锁乳突肌肌皮瓣12例和胸大肌肌皮瓣5例修复舌根癌术后组织缺损比较

目的比较应用胸锁乳突肌肌皮瓣和胸大肌肌皮瓣修复舌根癌术后组织缺损的优缺点。方法对12例胸锁乳突肌肌皮瓣修复舌根癌与5例胸大肌肌皮瓣修复舌根癌术后组织缺损的病例进行回顾性对比研究。结果17例患者中男12例,女5例,年龄42-77岁,修复范围约3.5cm×4.0cm-6.0cm×6.5cm,胸锁乳突肌肌皮瓣组2例皮瓣二期愈合,2例颈部创口二期愈合,其余肌皮瓣均愈合良好。术后1-2个月追加放疗,未见有皮瓣坏死。结论应用胸锁乳突肌肌皮瓣修复舌根癌术后组织缺损较胸大肌肌皮瓣修复更简便。     

真皮组织瓣转移修复口内粘膜缺损的实验研究

目的 研究真皮瓣修复口内粘膜缺损的愈合过程。方法　12只健康成年家犬的双侧颊部人为造成缺损,分别以带蒂颈阔肌真皮瓣与颈阔肌皮瓣立即修复,在愈合过程中以HE和PAS染色等对比观察转移后组织瓣的形态特征。结果 转移后真皮瓣中含皮肤附件较少,组织学结构类似正常皮肤。结论 真皮瓣是修复口内大面积粘膜缺损的较好选择之一,表面毛发生长少是其显著优点。     

颈阔肌皮瓣在颊癌术后缺损修复中的应用

目的：探讨颈阔肌皮瓣在颊癌术后缺损修复中的应用价值。方法术前检查颊部及颌下淋巴结未见显性转移的颊癌患者40例,观察组及对照组各20例,均常规实施颊癌切除和择区性颈淋巴清扫术,观察组颊部缺损选择颈阔肌皮瓣修复,对照组选择前臂皮瓣修复。随访1年,观察并比较2组患者皮瓣成活、颈部活动度、开口度以及颊部皮瓣黏膜化情况。结果观察组皮瓣成活率与对照组相比,差异无统计学意义（χ2=0.013,P=0.909）。但观察组内,皮瓣绕下颌骨者出现远端坏死的发生率明显低于未绕下颌骨者,差异有统计学意义（χ2=3.429,P=0.044）。颈阔肌皮瓣术后1年供区疤痕明显软化,对颈部活动影响不大,2组颈部活动度差异无统计学意义（P＞0.05）。2组患者术后1年的开口度及颊部皮瓣黏膜化情况均良好,差异无统计学意义（P＞0.05）。结论颈阔肌皮瓣对于术前颊部及颌下淋巴结未见显性转移的颊癌患者的术后缺损具有较好的修复效果,尤其适用于颊部病灶切除后有牙列缺失者,以及手术风险较高不宜实施游离皮瓣者。与游离皮瓣相比,颈阔肌皮瓣具有手术创伤小、临床效果好、操作简单容易开展等优点。     

肌蒂型颈阔肌肌皮瓣在颊黏膜缺损修复中的应用

目的 探讨肌蒂型颈阔肌肌皮瓣（PMF）的主要特点、优点、皮瓣制备的改良措施,并评价其在颊黏膜缺损修复中的应用价值。方法 选取2012年8月—2015年4月采用经MacFee切口的改良肌蒂型PMF修复因癌前病变及良恶性肿瘤切除导致的颊黏膜缺损23例。掀起皮瓣蒂部皮肤时,将大部分皮下脂肪置于颈阔肌表面;保持面动静脉的连续性;携带颈外静脉在颈阔肌的背面。结果 23例病例中21例皮瓣完全成活,2例皮瓣部分坏死,另有2例颈部伤口愈合不良,经换药处理均二期愈合。所有病例经11~43个月随访,受区功能恢复良好,除2例颈部伤口愈合不良病例遗留较大面积瘢痕外,其余病例颈部外形满意,无局部及颈部复发病例。结论 和传统PMF比较,肌蒂型PMF可提供更大的皮岛面积,功能美学效果更佳,是修复颊黏膜缺损的一种新的理想选择。     

Two designs of platysma myocutaneous flap for reconstruction of oral and facial defects following cancer surgery

This study evaluates the effects of two different designs of platysma myocutaneous flap, vertical and transverse, used in the reconstruction of defects following the excision of oral and facial tumors. Modified radical neck dissection or selected neck dissection was also performed. Out of the 48 patients, vertical and transverse platysma myocutaneous flaps were used for 41 and 7, respectively. The postoperative outcome for the vertical flaps was 37 cases surviving, two cases of complete necrosis, and two cases of partial necrosis. With the transverse flaps, six survived and there was one case of complete necrosis. The success rate was 90.2% and 85.7% for the vertical and the transverse flap, respectively. The form and function of recipient sites were well recovered. In conclusion, the platysma myocutaneous flap has clinical value in selected patients needing reconstruction of small and medium-sized intraoral or facial defects. It is recommended that the vertical design be used for reconstruction of buccal mucosa defects, and the transverse design for mouth-floor and facial defects.     

胸锁乳突肌-耳大神经瓣修复颈清扫术中缺损的副神经

目的　总结颈清扫术中用胸锁乳突肌 耳大神经瓣修复副神经缺损的一种方法。方法　将 34例需行传统根治性颈清扫术患者分为单纯颈清扫术组 ( 19例 )及副神经重建组 ( 15例 ) ,副神经重建组缺损副神经用新修复方法处理 ,比较两组病例术后肩功能恢复状况。结果　副神经重建组的术后肩部疼痛、肩臂活动能力及臂外展角度均明显优于单纯颈清扫术组。结论　利用胸锁乳突肌 耳大神经瓣修复缺损副神经是一种简单、有效、充分利用组织和不会带来并发症的可靠方法     

小腿内侧皮瓣在口腔颌面部术后缺损修复中的应用

目的：评价小腿内侧皮瓣在口腔颌面软组织缺损修复中的价值。方法：对2例累及舌腹部及下颌舌侧骨板的口底鳞癌．行原发灶根治术及保留颏部下缘的颏部截除术：4例舌癌均行原发灶根治术．术中保留下颌舌侧牙龈，未行下颌骨骨段切除术：2例颊部鳞癌患者行保留下颌骨下缘的原发灶根治术；8例患者均行颈淋巴清扫术．术中解剖出面动脉、颈外静脉和颈前静脉，再根据口腔缺损的范围制备相应大小及形状的皮瓣，皮瓣以胫后动、静脉为蒂。将皮瓣的胫后动脉与面动脉吻合，将皮瓣的胫后静脉与颈外静脉（或颈前静脉）吻合．然后将皮瓣与缺损区边缘严密缝合。结果：8例小腿内侧皮瓣均获得成功，口内、外伤口愈合良好，修复效果良好，覆盖于小腿内侧皮肤缺损区的皮片全部成活。结论：小腿内侧皮瓣适用于舌、口底、颊部及面颈部软组织缺损的修复。口腔颌面部肿瘤术后软组织缺损．可利用携带部分比目鱼肌的小腿内侧皮瓣进行修复。     

The posteriorly based platysma flap in oral and facial reconstruction: A case series.

PURPOSE: The purpose of this study was to assess the reliability and use of the posteriorly based platysma flap for oral and facial reconstruction. PATIENTS AND METHODS: This case series consists of 7 patients who were reconstructed with a posteriorly based platysma flap for various tumor resection defects of the oral and facial region. The flaps were monitored for complications, including skin loss and ischemia in the postoperative period. RESULTS: Three of the patients (43%) in this study had no complications. Three patients (43%) had some skin sloughing, but the underlying muscle remained viable and mucosalized normally. One patient (14%) had 40% flap loss of the distal end, possibly due to vascular compromise that occurred during a concomitant neck dissection. CONCLUSION: The posteriorly based platysma flap is a reliable reconstruction option for defects in the facial and oral region. If skin sloughing occurs, it is usually inconsequential for intraoral reconstruction as the underlying muscle remains viable and undergoes epithelialization.     

The superiorly based platysma flap for oral reconstruction in conjunction with neck dissection: a case series.

PURPOSE: The purpose of this study was to access the reliability and use of the superiorly based platysma flap for reconstruction of small and medium oral defects. PATIENTS AND METHODS: This case series consists of 5 patients who were reconstructed with a superiorly based platysma flap for defects of the following oral region: buccal mucosa, floor of the mouth, and lateral gingiva. The flaps were monitored for complications, including skin loss and ischemia in the postoperative period. RESULTS: Three patients (60%) had some skin sloughing in the recipient site. None of the patients had complications in the donor site. CONCLUSION: The superiorly based platysma flap can survive after the facial artery has been ligated, which is the normal procedure during neck dissection. If skin sloughing occurs, it is usually inconsequential for intraoral reconstruction because the underlying muscle remains viable and undergoes epithelialization.     

Anatomy of the platysma muscle and the evaluation of it for the reconstruction of facial defects

Reconstruction of the defects with various flaps is the main issue in plastic and reconstructive surgery. Tissues used for the repair of the defects of the face should be convenient for this most important aesthetic unit. Color, elasticity, and volume of the transferred tissues have the utmost importance for successful results. Platysma muscle flap appears to be a good alternative method for the reconstruction of the facial defects. Anatomic dissections on five fresh cadavers for the evaluation of the vascular structures and 11 clinical cases of reconstruction of the defects of the face and the neck with platysma muscle and musculocutaneous flaps are performed in this study to evaluate the efficacy and reliability of platysma flaps. Cadaveric dissections were performed on the face and the neck regions on both sides. Eleven patients with various defects on the face and the upper neck regions were surgically treated: three transverse cervical artery-based transverse musculocutaneous platysma flaps, seven facial artery-based vertical musculocutaneous platysma flaps, and one superior thyroidal artery-based platysma muscle flap were used for the repairs. The patients ranged in age from 42 to 74 years. The defects measured 2x3 cm to 6x9 cm and the flaps 3x3 cm to 7x10 cm. The follow-up periods were 2 to 21 months. Postoperative venous congestion between the 5th and 9th days was observed in seven patients. One patient had infection of the donor site, and another had infection of the recipient site; both recovered with systemic and topical antibiotherapy. Partial flap loss occurred in one patient. Our study concluded that platysma flaps showed sufficient tissue match with successful results for the reconstructive procedures of facial defects.     

Clinical review of three types of platysma myocutaneous flap

This study evaluated the survival rates of three types of platysma myocutaneous flap: transverse flap, vertical flap that preserved the facial artery and vein and vertical flap that sacrificed the facial artery and vein. Modified radical or supraomohyoid neck dissection was also performed in all patients. Out of 54 patients, transverse and vertical flaps were used for 12 and 42 cases, respectively. In 42 cases of vertical flaps, 26 cases preserved the facial artery and vein, 16 cases sacrificed them. Ten cases of the transverse flaps survived and two cases had partial necrosis. In the 26 cases of vertical flaps that preserved the facial artery and vein, 23 cases survived and three cases had partial necrosis. With the 16 cases of vertical flaps that sacrificed the facial artery and vein, 10 cases survived, four cases had partial necrosis and two cases had total necrosis. The flap survival rates were 83.3, 88.5 and 62.5%, respectively, in the transverse, vertical flap preserving the facial vessels and vertical flap that sacrificed them. The survival rates of transverse and vertical platysma myocutaneous flaps preserving the facial artery and vein were higher than vertical flap that sacrificed the facial artery and vein.