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。     

前臂皮瓣与股前外侧皮瓣修复口腔癌术后缺损的临床研究

目的 比较前臂皮瓣与股前外侧皮瓣在口腔癌术后缺损中的修复效果。方法 选取84例口腔癌术后缺损并行游离皮瓣修复术的患者为研究对象,按随机数字表法分为2组,各42例。对照组行前壁皮瓣修复,观察组行股前外侧皮瓣修复。观察至术后3个月,对比2组皮瓣成活率、手术情况、口腔功能、并发症。结果 2组皮瓣成活率、皮瓣制作时间、住院时间、口腔开合、吞咽、咀嚼、语言功能评分相比,差异无统计学意义(P>0.05);观察组手术时间长于对照组,皮瓣面积大于对照组,并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论 前臂皮瓣与股前外侧皮瓣均具有良好的皮瓣成活率,可有效改善口腔癌术后缺损患者的口腔功能,且治疗效果相当。前臂皮瓣修复手术时间短,股前外侧皮瓣修复术后并发症少,临床应根据患者具体情况选取适当的皮瓣修复。     

薄型股前外侧皮瓣修复舌癌术后软组织缺损的疗效分析

目的探讨薄型股前外侧皮瓣修复舌癌术后软组织缺损的效果。方法选取90例舌癌术后软组织缺损部软组织缺损患者,根据修复方法的不同分为薄型股前外侧皮瓣、前臂桡侧游离皮瓣、小腿内侧游离皮瓣各30例。皮瓣切取平均面积为(1.2×1.5)cm^2^1.8×2.5cm^2,比较3种手术方式的有效率及舌癌术后软组织缺损修复的满意度。结果 3种手术方式有效率间没有明显差异,无统计学意义(P=0.075);薄型股前外侧皮瓣修复舌癌术后软组织缺损满意度明显优于其他方法,具有统计学意义(P=0.069)。结论对舌癌术后软组织缺损部软组织缺损患者采用不同部位的游离皮瓣修复均取得了良好的修复效果,其中薄型股前外侧皮瓣修复满意度明显高于其他方法,提高患者的康复效果。     

股前外侧肌皮瓣在舌根缺损修复中的应用

目的 探讨股前外侧肌皮瓣修复舌根缺损的效果。方法 应用股前外侧肌皮瓣修复舌根鳞癌术后缺损一例，术后随访。结果 术后创口一期愈合，一年后随访舌体外形良好，吞咽及语言功能满意。结论 该肌皮瓣动脉血管蒂恒定、皮下脂肪较厚，适于修复舌根软组织缺损；皮瓣血管口径较大．易于吻合；供区隐蔽，取瓣方便。     

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。     

游离股前外穿支皮瓣在原发体表恶性肿瘤术后创面修复中的应用

摘 要：［目的］ 探讨游离股前外穿支皮瓣在原发体表恶性肿瘤术后创面修复中的应用价值。［方法］ 2015~2017年完成游离股前外穿支皮瓣原发体表恶性肿瘤术后复杂创面修复15例,其中足底皮肤黑色素瘤5例,皮肤鳞癌3例,复发软组织肉瘤7例。皮肤缺损面积5cm×6cm~20cm×30cm。［结果］ 肿瘤达R0根治,皮瓣均成活。3例术后血管危象,二次探查后成活。随访3~33月,未见肿瘤复发。供区愈合良好,无下肢活动障碍。［结论］ 游离股前外穿支皮瓣应用于体表恶性肿瘤术后创面缺损修复安全有效,值得进一步推广。     

21例舌癌游离股前外侧皮瓣舌再造术临床体会

[目的]探讨游离股前外侧皮瓣在舌癌缺损修复舌再造术中的应用价值.[方法]回顾并分析2004年2月～2005年12月,应用游离股前外侧皮瓣修复舌癌术后缺损舌再造术21例.[结果]21块游离瓣全部成活,术后血栓发生率4.8%(1/21).随访3个月～2年,再造舌形态丰满、功能满意.1例(T4N1M0)术后1年因颈淋巴结转移死亡,未发现舌局部复发者.[结论]游离股前外侧皮瓣移植安全可靠,供区隐蔽功能影响小,皮瓣厚度适宜,是修复舌癌术后缺损舌再造术的优良供区,值得推广普及.     

游离股前外侧皮瓣修复口腔癌术后缺损的初步观察

目的 探讨游离股前外侧皮瓣在口腔癌术后缺损修复中的应用效果.方法 回顾分析2004年12月至2007年8月完成的11例游离股前外侧皮瓣移植病例.分析皮瓣的设计、皮瓣成活情况、术后并发症及影响组织瓣成活的各种因素.结果 11例游离皮瓣中,面积8 cm×5 cm至12 cm×7 cm,平均10.2 cm×6.2 cm,除1例术后14 h出现血管危象,经抢救失败后,放弃皮瓣,其余10例皮瓣全部存活.结论 游离股前外侧皮瓣在口腔癌术后缺损的修复中具有较大灵活性,组织丰实,供区隐蔽,值得临床进一步应用.     

CTA并三维重建技术在指导游离股前外侧皮瓣制备中的应用

目的:应用CTA并三维重建技术对穿支进行定位和选择,设计皮瓣及手术方案,以期最合理制备游离股前外侧皮瓣.方法:2012年6月至2014年12月间,60例头颈肿瘤切除术后拟行游离股前外侧皮瓣修复的患者,随机分配成A、B组.A组术前双侧下肢CTA血管成像并三维重建,指导设计皮瓣;B组术前以彩色多普勒定位穿支.比较两组准确率、取瓣成功率、平均花费时间、供瓣区多余创伤等方面的差别.结果:A组中2例术前血管成像不满意,未实施计划.其余28例手术均按计划取瓣成功.B组术前1例未发现穿支,其余29例均探测到穿支,但术中发现穿支定位有一定误差.A组在取瓣成功率、取瓣时间优于B组,供瓣区多余创伤小于B组.结论:应用CTA并三维重建技术,术前对股前外侧皮瓣穿支进行选择和定位,可以提高制备皮瓣的成功率,节省手术时间,并最大限度减少供区创伤,尤其设计多瓣进行复杂缺损的情况下具有明显优势,值得推广.     

股前外侧皮瓣在口腔颌面部修复重建中的临床应用

目的 探讨修复各类口腔颌面部缺损时应用游离股前外侧皮瓣的可能性和实用性。方法 2011年3月至2018年12月共开展股前外侧皮瓣移植术63例,皮瓣最小面积4×6 cm,最大面积7×22 cm;修复缺损部位有舌部26例,颊部15例,口底区8例,下颌6例,口咽部3例,上颌2例,软腭2例,面部大面积缺损1例。其中,肌皮瓣55例,分叶皮瓣8例。术中一期削薄48例,其中粗修46例,精修2例。结果 游离股前外侧皮瓣的临床成活率为98.4％(62／63)。术后血管危象2例,其中1例抢救成功,失败1例,组织瓣坏死。削薄皮瓣均无坏死,无大腿皮瓣供区感染。术后患者均获得可接受的面部外形以及咀嚼、吞咽和语言功能。结论 游离股前外侧皮瓣可以很好的修复口腔颌面部各种复杂的缺损。     

游离股前外侧皮瓣修复头颈部缺损术后供区功能调查

目的:评价股前外侧皮瓣(ALT)修复头颈部缺损术后供区的功能,为选择ALT皮瓣修复头颈部软组织缺损提供理论依据.方法:应用问卷调查的方法随访2004-11-2008-05于中山大学肿瘤防治中心应用ALT皮瓣修复头颈部缺损的14例患者,评价手术对供区外观满意度、感觉及运动功能的影响.结果:所有患者供区伤口均能一期拉拢缝合...     

股前外侧皮瓣在外阴肿瘤术后的修复应用

Objective  

The aim of this study was to evaluate the value of the application of anterolateral thigh flap in postoperative repairing of vulva tumor.     

Use of the double-paddle anterolateral thigh flap for locally advanced tongue carcinoma requiring second site reconstruction

BackgroundAdvanced oral tongue carcinoma can present with extension beyond the oral cavity. Operative defects after resection may involve multiple anatomical sites and significantly impact speech and swallowing. Dependence on long-term enteral feeding is not uncommon for these patients. The anterolateral thigh (ALT) flap is one of the most reliable and flexible flaps used in the reconstruction of total and subtotal tongue defects. The double-paddle flap modification may be a more suitable option for complex oral tongue defects after advanced tumor ablation.MethodsCase series of 31 patients with oral tongue squamous cell carcinoma that were classified as stage IV. The age of patients ranged from 32 to 63 years. We designed the double-paddle ALT flaps to reconstruct the two-site surgical defects (tongue defect and pharynx or neck skin defect). Postoperative viability of the flap was checked by clinical observation. The last examination was performed at 3-months after the completion of adjuvant chemoradiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) using a Speech Intelligibility Score and the Functional Oral Intake Scale.ResultsA total of 31 patients with surgical defects after total or subtotal tongue resection for cancer underwent double-paddle ALT flaps for reconstruction from March 2018 to December 2019. The dimension of flaps from 8 × 12 cm to 10 × 18 cm were divided into double-paddle from 8 × 5 cm to 10 × 10 cm. There was one case of pedicle thrombosis, one case of postoperative bleeding, three cases of neck infection, and six cases of salivary fistula. Our patients were seen in follow up from 6 to 36 months, with median follow-up of 23.5 months. The survival rate of ALT flap was 100%. All of our patients achieved an oral diet by 9 months after surgery. The mean score speech intelligibility was 2.74 ± 0.68 (4-point ordinal scale). The 2-year disease-free survival rate was 61.3%.ConclusionsThe double-paddle ALT flap is a reliable flap suitable for oral defects involving multiple subsites after ablative procedures. The majority of patients demonstrated acceptable functional rehabilitation.Clinical question/ level of evidenceTherapeutic, IV.     

Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction

Background

The anterolateral thigh (ALT) flap is a frequent choice for free flap transfer in head and neck cancer reconstruction because of its versatility. Preoperative mapping of the perforator pedicles of an ALT flap is still a challenge because of variations in vasculature. Although computed tomographic angiography (CTA) is used increasingly to evaluate the peripheral vasculature, the use of this method for evaluating the perforators of an ALT flap has not been described in detail.

Methods

From September 2008 to March 2009, 32 patients underwent preoperative CTA before free ALT flap transfer for head and neck cancer reconstruction. The perforators were marked on a 64-section multidetector CT image for each patient. The preoperatively mapped perforators were compared with the actual intraoperative findings. Flap success rates and associated morbidity and complications were recorded.

Results

Preoperative CTA identified major variations in perforators. Eighty-four were found by preoperative CTA; 64 of these were mapped to be explored during the operation, and 13 additional perforators were identified during surgery. The accuracy rate of identifying the branching origin of the ALT perforators was 98% (63/64). All of the ALT flaps survived except for one with necrosis (survival rate 97%). There was no donor site morbidity.

Conclusions

Preoperative mapping of perforators by CTA proved valuable in free ALT flap transfer and shortened the operation time significantly. This modality provides useful information for head and neck cancer reconstruction in difficult cases, especially in patients with large or through-and-through defects that might need multiple perforators in flap design.     

修复口腔癌术后缺损的股前外侧皮瓣供区积液的临床分析

背景与目的：股前外侧皮瓣（anterolateral thigh flap,ALTF）是口腔癌术后修复最常用的皮瓣。通过回顾分析口腔癌手术病例,探讨如何最大限度地降低ALTF制备术后供区积液的发生率。方法：选择2018年4月—2018年12月于上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科住院的病例,共149例,根据ALTF制备及供区处理方式的不同,分为3组：第1组,大腿阔筋膜上制备ALTF（阔筋膜上ALTF）37例,关创时将阔筋膜对位缝合,术后大腿供区未行加压包扎;第2组,大腿阔筋膜下制备ALTF（阔筋膜下ALTF）66例,术后因阔筋膜缺损多、张力过大,不能拉拢缝合,术后大腿供区配合绷带加压包扎;第3组,大腿阔筋膜下制备ALTF 46例,术后阔筋膜缺损多、张力过大,不能拉拢缝合,术后大腿供区未行绷带加压包扎。术后随访1个月,观察大腿供区积液发生情况。结果：大腿供区术后积液总的发生率为10.07%,其中第1组积液发生率为0.00%,第2组积液发生率为10.61%,第3组积液发生率为17.39%,各组间比较差异有统计学意义（P<0.05）。结论：大腿阔筋膜上制备ALTF较阔筋膜下制备ALTF的供区处理方式能够有效降低供区术后积液的发生率。对已制备阔筋膜下ALTF的病例,对大腿供区进行加压包扎,可起到降低供区积液发生率的作用。