累及相邻器官的晚期舌癌的手术治疗:附1例报告

报告1例晚期舌癌患者实施多器官联合切除同期双游离瓣修复术,术中切除全舌、双侧口底、右下颌骨及左下颌骨颏部、部分右上颌骨、右软腭、右扁桃体、会厌、舌骨及全喉,制备右腓骨肌瓣、左腹直肌肌皮瓣移植修复软硬组织复合缺损,临床疗效满意。推荐对晚期口腔癌患者施行救治性外科及重建。     

腹直肌-腹膜瓣修复舌缺损的临床研究

目的 探讨腹直肌-腹膜瓣修复舌缺损的临床效果。方法2003年9月至2004年4月，5例舌癌患者接受了舌癌联合根治术同期腹直肌-腹膜瓣修复术。腹直肌．腹膜瓣包括腹直肌、腹直肌后鞘、腹膜、肋间神经及腹壁下动静脉。术中将肋间神经与舌下神经降支吻合。结果全部腹直肌-腹膜瓣成活。术后随访至今，无严重并发症，再造舌外形及活动度满意，语音、吞咽功能接近正常。术后2个月组织学检查证实腹膜上皮化。结论腹直肌-腹膜瓣行半舌再造的初步临床效果满意。     

游离腹直肌皮瓣在口腔颌面大型缺损Ⅰ期修复中的应用

目的：探讨应用游离腹直肌皮瓣修复口腔颌面部癌术后大型缺损的可行性。方法：对18例口腔颌面部肿瘤切除术后大型缺损即刻游离移植腹直肌皮瓣修复,对临床资料进行分析和总结。结果：随访3～24个月,18例皮瓣完全成活,成活率100％。结论：腹直肌皮瓣游离移植是修复口腔颌面部大型缺损可靠和理想的方法。     

舌根癌全舌切除临床治疗（附2例报告）

目的：探讨舌根癌全舌切除的临床治疗。方法：对2例舌根癌患者分别行保留少量舌根组织的全舌切除加游离腹直肌肌皮瓣舌再造术及全舌、会厌切除加带蒂胸大肌肌皮瓣全舌再造术。结果：两种皮瓣均可有效修复全舌切除术后的组织缺损,再造舌的形态满意。2例病例均获成功,19个月后复查皮瓣成活良好且肿瘤无复发,保留部分舌根患者语音及进食恢复较好。结论：带蒂胸大肌肌皮瓣及游离腹直肌肌皮瓣均可作为全舌切除后组织缺损的有效修复方法;保留舌根与否及保留组织的多少对再造舌术后的功能有较大影响。     

游离腹直肌皮瓣在口腔颌面部缺损修复中的应用

目的 研究游离腹直肌皮瓣修复口腔颌面部缺损的方法和价值。方法 1999年7月～2000年7月完成21例游离腹直肌皮瓣,分析组织瓣的大小、受区血管、血管吻合方式和技术、皮瓣成活情况、术后并发症及影响皮瓣成活等因素。结果21例组织瓣中20例成活,1例坏死,皮瓣的成功率为95.2％。受区和供区总的并发症发生率为33.3％。早期4例中有2例发生供区切口疝,经保守治疗好转。通过采用聚丙烯酸膜片腹直肌前鞘修补技术,后来的17例均未发生切口疝。吸烟、饮酒、放疗和年龄（高龄和儿童）等均非影响游离腹直肌瓣成功的重要因素。结论 游离腹直肌皮瓣适用于口腔颌面部大型缺损的修复与重建,优于传统的带蒂组织瓣移植。     

Salvage reconstruction of extensive recurrent oral cancer defects with the pectoralis major myocutaneous flap.

PURPOSE: This study aimed to evaluate the usefulness of the pectoralis major myocutaneous flap for reconstruction of oral and facial defects after excision of recurrent oral cancer and the results of salvage surgery. PATIENTS AND METHODS: Twenty-four patients with recurrent squamous cell carcinoma of the oral cavity underwent salvage surgical treatment. Pectoralis major flaps were used for reconstruction of the extensive defects caused by excision of the tumors. The complications of the flap and the prognosis of the patients were analyzed with a follow-up from 5 to 65 months (mean = 18.5 months). RESULTS: Fourteen flaps were used for mucosal lining of the mouth, and 10 flaps were used for reconstruction of the cutaneous defects. The overall success rate of the flap was 70.8%. Flap-related complications developed in 13 patients (54.2%). Major complications occurred in 7 patients (29.2%), and minor complications occurred in 6 (25.0%). Three patients (12.5%) had complications unrelated to the flap. The reconstruction of the base of the tongue, the floor of the mouth, and the oropharynx emerged as a significant risk factor for flap necrosis on binary logistic regression analysis (P < .05). The overall 1-, 3-, and 5-year overall survival rate was 72.8%, 30.9%, and 20.6%, respectively. CONCLUSION: The pectoralis major myocutaneous flap is a reliable choice for reconstruction of extensive soft tissue defects caused by excision of recurrent oral cancer. The major complications correlate with the site of reconstruction. Many patients benefit from salvage surgery, and some of them can survive 2 to 4 years postoperatively.     

Functional and aesthetic reconstruction of full-thickness cheek, oral commissure and vermilion

PURPOSE: This paper presents surgical techniques for reconstruction of the cheek, oral commissure and vermillion in the repair of full-thickness cheek defects after resection of buccal-mucosal squamous cell carcinoma. PATIENTS AND METHODS: Four reconstructions in one-stage surgery with either a free radial forearm flap or a rectus abdominis musculocutaneous flap for cheek and oral commissure were carried out. There were combined with a new approach for vermillion advancement flaps. Most challenging was the need not only for morphological reconstruction of the orifice, but also for physiological reestablishment of sphincteric and sensory functions in the vermillion. RESULTS: Morphological and physiological reconstruction of the lip with sphincteric and sensory functions was attained. CONCLUSION: This valuable reconstruction technique was demonstrated in large, full thickness defects involving the cheek, oral commissure and vermilion.     

Latissimus dorsi free flap reconstruction of anterior skull base defects

IntroductionSurgery of extensive skull base tumour results of a defect of soft and hard tissue and dura. Free flap reconstruction provides tissue to restore the defect and separate the intracranial content from the bacterial flora of the nasal fossae. Vertical and transverse rectus abdominis myocutaneous free flap are usually used. This study was designed to compare our experience of latissimus dorsi free flap reconstruction of extensive skull base defects after tumour resection with the literature concerning the use of other types of free flaps.Material and methodAll extensive skull base tumour resections with latissimus free flap reconstruction made in the head and neck oncology unit of the Institut Curie, Cancer Centre, between January 2004 and December 2009 were reviewed.ResultsTwo infectious complications were observed (11.7%), two cases of CSF leak (11.7%), one case of wound dehiscence following tumour resection comprising the nasal skin (5.9%) and one case of partial distal necrosis of the flap in a zone of skin resection (5.9%) were observed. No flaps were lost. Two latissimus dorsi donor site haematomas were observed (11.7%).ConclusionWhen reconstruction of extensive skull base defect need free flap, the latissimus dorsi free flap is a reliable solution.     

Free and locoregional flap associations in the reconstruction of extensive head and neck defects

Head and neck surgical defects after oncological resection of advanced carcinoma involving the oral cavity are often composite and involve bone, mucosa, soft tissues and skin. For the most extensive defects, the simultaneous association of two free flaps is the best choice to improve the function of the preserved structures. This procedure is difficult and involves prolonged surgery, therefore it is only possible in selected patients. In some composite head and neck defects the association of free and locoregional flaps seems to be indicated. This study, discusses the use of free and locoregional flap association, focusing on its aesthetic advantages and functional results. From January 1995 to December 2006, 30 patients received simultaneous locoregional and free flap transfer for closure of post-ablative oral cavity defects. Microvascular tissue transfer included the radial forearm, anterolateral thigh, rectus abdominis, and fibula and iliac crest free flaps. Locoregional flaps included the cervicofacial, cervicopectoral, deltopectoral, pectoralis major, latissimus dorsi and posterior scalp flaps. Based on the good functional and aesthetic outcome and low rate of complications, the association of free and locoregional flaps represents a good reconstructive option for patients with extensive post-oncological composite head and neck defects.     

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。     

胸大肌肌皮瓣修复口腔颌面部缺损并发症的临床分析

目的 ：探讨胸大肌肌皮瓣修复肿瘤术后口腔颌面部缺损发生并发症的主要因素及减少其发生的措施。方法 ：对2010—2015年采用胸大肌肌皮瓣修复口腔颌面部缺损的78例患者进行回顾分析。结果 ：16例患者出现与胸大肌肌皮瓣有关的并发症（20.51%）,其中感染14例（17.65%）,皮瓣不同程度坏死9例（11.54%）,形成瘘管6例（7.69%）。结论 ：并发症的发生主要与患者的性别、年龄、全身状况（糖尿病、高血压）、皮瓣损伤、引流不畅有关,严格的适应证选择、精细的手术操作可有效减少并发症的发生。     

游离组织瓣移植同期修复下颌骨放射性骨坏死术后缺损

目的　探讨游离组织瓣移植在晚期下颌骨放射性骨坏死治疗中的可靠性和应用价值。方法　采用游离组织瓣移植同期修复11例晚期下颌骨放射性骨坏死术后缺损的患者。分析原发肿瘤的部位和类型、放疗剂量、缺损的范围、所采用游离瓣的设计、受区血管的选择、游离瓣的成活情况及术后并发症的发生情况。结果　11例患者共采用15块游离组织瓣修复缺损,包括12块游离腓骨瓣、2块腹直肌皮瓣和1块前臂皮瓣。1例患者采用3块游离瓣修复(腓骨瓣、腹直肌瓣和前臂瓣),2例患者采用2块游离瓣修复(腓骨瓣和腓骨瓣,腓骨瓣和腹直肌瓣),余9 例患者各采用1块游离瓣修复。全部游离瓣均获得成活,无1例出现血管危象及组织瓣的全部或部分坏死。全部患者术后放射性骨坏死的症状均完全缓解,外形和功能也得到了不同程度的恢复,随访期间未见有肿瘤和放射性骨坏死复发。结论　对于晚期的下颌骨放射性骨坏死,采用病灶切除同期游离组织瓣移植是有效可行的方法,游离腓骨瓣是修复下颌骨缺损的首选。     

四种组织瓣移植修复颊部洞穿缺损的比较研究

目的：比较折叠双皮岛游离前臂皮瓣、腹直肌皮瓣、股前外侧皮瓣和带蒂的胸大肌皮瓣移植修复颊部洞穿缺损的适应症和效果。方法：自2002年2月～2010年6月收治15例口腔颌面部恶性肿瘤患者,肿瘤根治性切除后遗留的颊部洞穿缺损大小范围（包括皮肤和黏膜）：32-76 cm2。根据患者的年龄、性别、体型及缺损的部位和大小等情况,分别采用游离前臂皮瓣（3例）、腹直肌皮瓣（4例）、股前外侧皮瓣（2例）或带蒂胸大肌皮瓣（6例）折叠修复,分析和评价修复效果。结果：本组15例随访3个月～7年,除2例胸大肌皮瓣远端小部分坏死外,其余移植皮瓣均成活。面部外形恢复良好,张口不受限。结论：前臂皮瓣较薄,适于修复上颊部或前颊部洞穿缺损,腹直肌皮瓣和胸大肌皮瓣较厚,适于修复伴下颌骨缺损的下颊部和后颊部洞穿缺损,股前外侧皮瓣厚度中等,并可根据需要削薄,适于修复颊部任何区域的洞穿缺损。     

腹壁下动脉穿支皮瓣在全舌癌缺损修复中的应用效果评价

目的: 评价游离腹壁下动脉穿支皮瓣（deep inferior epigastric perforator,DIEP）用于舌癌术后全舌缺损修复的效果。方法: 2018年1月—2018年7月应用游离DIEP修复13例舌癌患者,手术缺损部位均为全舌或近全舌缺损。术中将腹壁下动脉与甲状腺上动脉或面动脉吻合,伴行静脉与颈外静脉或颈内静脉属支吻合。结果: l3例DIEP皮瓣均修复成功,皮瓣外观满意。术后随访舌形态良好,功能满意。供区直接闭合,其中1例患者皮瓣供区出现感染,经换药后愈合。所有腹部伤口均为线性瘢痕,腹直肌功能未受明显影响,未发现腹壁疝和腹壁隆起等手术并发症。结论: 腹壁下动脉穿支皮瓣组织量丰富、血供可靠、质地柔软,再造舌外形及功能良好,且供区保留了腹直肌和前鞘,损伤小,将供区并发症降到最低限度,是舌癌术后全舌缺损修复新的可靠技术。     

1 212块股前外侧肌皮瓣在口腔颌面缺损修复中的应用

目的 探讨游离股前外侧肌皮瓣在口腔颌面部修复重建的价值。方法 收集2002年2月-2013年6月间在中南大学湘雅二医院口腔颌面外科住院,进行了股前外侧肌皮瓣修复的患者1 185例（1 212块皮瓣）。记录并统计患者的基本资料、缺损部位、皮瓣的面积及类型、受区血管的处理方法、供区并发症、患者术后生存质量等情况。结果 1 212块皮瓣成活1 176块,坏死36块,成活率97.0%。皮瓣供区无严重并发症出现。股前外侧肌皮瓣重建口腔颌面部各个部位的缺损后,90%以上的患者得到了良好的功能恢复及美观效果。吻合1根静脉与吻合2根静脉相比,可以显著地缩短显微操作时间（P=0.000 3）。2组的静脉危象发生率、抢救成功率及静脉危象导致的皮瓣坏死率均无统计学差异（P>0.05）。结论 股前外侧肌皮瓣组织供应量大,可满足口腔颌面部各个部位缺损的修复要求。股前外侧肌皮瓣比其他游离皮瓣,更适合用于口腔颌面部缺损修复,应作为首选皮瓣。     

舌癌术后缺损6种皮瓣修复方法的临床疗效分析

目的:探讨舌癌扩大切除术后舌缺损修复重建的有效方法。方法:对2006-03—2010-07我科收治的69例舌癌患者实施手术治疗,造成的舌缺损用各种皮瓣转移即时修复,术后观察皮瓣成活率、并发症、语音清晰度和吞咽功能的恢复情况。结果:皮瓣成活率98.5%,供区创面均一期愈合。术后随访2～2.5年,重建舌体、口底形态基本满意,语言、吞咽功能大部分恢复;3例患者发生并发症(4.35%),其中次全舌缺损2例和全舌缺损1例。结论:了解舌修复重建的原则及选择合适的修复方法有助于达到舌缺损更好的修复效果。     

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。     

Reconstruction of large performated maxillofacial defect with immediated revascularized flap]

Patients with large perforated maxillofacial defects resulting from combined craniomaxillofacial resection or extended extra cranio-maxillofacial resection due to malignances in this region had been reconstructed with large revascularized myocutaneous flap or combined pedicled myocutaneous flap with revascularized flap.Since January,1981,a total of 29 flaps was used,of which 28 flaps survived successfuly,whereas one free forearm flap being failed to survive due to venous embolization was replaced with pedicled forehead flap.The results in postoperative appearance and rehabilitation of physiological function were relatively satisfactory.Finally,selection of flap and method of reconstruction were introduced and experiences on immediate reconstruction after malignance resection reported.     

Free-flap reconstruction of the scalp: donor selection and outcome

Wide, complex defects of the scalp caused by various insults always represent reconstructive challenges for surgeons. Our study group consisted of 18 patients (14 males and 4 females) with a mean age of 40.2 years. Nineteen free-tissue transfers were used to reconstruct the scalp defects. The selected cases included 8 latissimus dorsi muscle flaps, 3 latissimus dorsi myocutaneous flaps, 2 rectus abdominis muscle flaps, 3 omental flaps, 1 scapular flap, 1 radial forearm flap, and 1 groin flap. Twelve patients had acute or subacute wounds resulting from trauma or craniotomy, 4 had primary cancer, and 2 had neurofibromatosis. Commonly used recipient vessels were the superficial temporal artery and vein. No flap procedure had morbidity due to vessel compromise, and the overall flap success rate was thus 100%. No major donor-site morbidity was observed. All cases underwent primary closure of donor sites except for one receiving split-thickness skin grafting. In cases where muscle or omental free flaps covered skin grafts, patients were more satisfied because of increased durability and well-fitted wigs. We advocate variable free-tissue transfers for the reconstruction of large defects of the scalp related to the sizes, sites, and extents of the involvement.