股前外侧筋膜瓣在头颈部修复的应用研究进展

有些头颈部恶性肿瘤手术造成的复杂缺损给医生带来挑战,股前外侧皮瓣、前臂皮瓣、游离腓骨皮瓣等都是常见的修复选择供区。近年来,股前外侧脂肪筋膜瓣在头颈部的修复重建中也得到较多的应用。论文收集近期的文献资料,综述股前外侧筋膜瓣的应用解剖特点以及对该皮瓣在头颈部各个亚单位的修复应用现状进行文献复习,总结该皮瓣使用的适应证、优缺点,以提高临床医生对该筋膜瓣的认识。     

游离股前外侧皮瓣制作的教学研究

自从1984年Song等报道游离股前外侧皮瓣的解剖以来，游离股前外侧皮瓣得到了广泛的研究和应用。1997年Kimata等埘首先报道了其在头颈部缺损修复重建中的临床应用，截止到2008年2月，已有大量应用该皮瓣修复头颈部缺损的报道。股前外侧皮瓣具有提供的皮肤和软组织量大（最大可达20cm×25cm），可携带肌肉，可塑性强（可修成5mm薄），供区畸形及并发症少等优点，在很多头颈部的修复中有取代前臂皮瓣的趋势。我科自2002年开展游离股前外侧皮瓣修复头颈部缺损，迄今已经有20余例，现对皮瓣制作中的教学体会加以总结，供同道参考。     

股前外侧皮瓣修复颊部大面积洞穿性组织缺损

目的探讨应用股前外侧皮瓣修复颊部肿瘤切除术后大面积洞穿性组织缺损的方法及疗效。方法 2006年10月～2009年10月应用游离双皮岛股前外侧穿支皮瓣,Ⅰ期修复颊部肿瘤切除术后大面积洞穿性缺损19例,面颊面皮肤缺损范围8cm×6cm～4cm×4cm,口颊面黏膜缺损范围9cm×7cm～6cm×5cm,所用股前外侧皮瓣面积20cm×8cm～12cm×6cm。结果 19例游离股前外侧穿支皮瓣全部成活,其中18例创面Ⅰ期愈合;1例颊部皮肤面部分坏死,黏膜面成活,经换药后伤口愈合。结论游离股前外侧穿支皮瓣组织量丰富,修复颊部缺损形态与功能保持好,是修复颊部大面积洞穿性缺损的理想皮瓣。     

应用不同入路切取股前外侧皮瓣行舌癌切除后缺损的修复重建

摘要：目的探讨不同入路股前外侧皮瓣修复舌癌术后缺损的效果。方法选择舌鳞状细胞癌患者78例,依据术中舌缺损的部位及形状设计股前外侧皮瓣,分别随机采用内侧入路和外侧入路切取皮瓣,每组各39例。比较两组皮瓣切取时间及供区损伤的差别。结果内侧入路组切取皮瓣的时间明显低于外侧入路组。内侧入路皮瓣组供区阔筋膜有16例直接闭合（41%）,外侧入路全部直接闭合（100%）。所有供区皮肤直接闭合。78例股前外侧皮瓣完全成活,2例发生血管危象,探查后缓解,皮瓣完全成活。皮瓣供区愈合良好,无骨筋膜室综合征表现,未发生感染。术后随访9~28个月,舌形态良好,咀嚼、吞咽、发音功能恢复较好。供区无运动感觉功能障碍。结论应用内侧入路和外侧入路都可以安全切取股前外侧皮瓣。     

游离股前外侧穿支皮瓣重建头颈肿瘤术后缺损

目的 探讨应用游离股前外侧穿支皮瓣重建头颈肿瘤切除术后组织缺损的方法及其效果.方法 2006年7月～2011年12月采用游离股前外侧穿支皮瓣修复头颈恶性肿瘤切除术后组织缺损75例,男52例,女23例;最大年龄80岁,最小年龄24岁,其中舌癌42例,颊癌20例,软腭癌2例,扁桃体癌9例,眶部肿瘤1例,外耳道癌1例.组织缺损范围8cm×5cm～18cm×10cm,病程4～24个月.结果 75例应用股前外侧穿支皮瓣游离移植修复,仅2例股前外侧皮瓣远端因静脉回流障碍发生部分坏死,其余均成活,皮瓣成活率97.3％,3例供区部分植皮未成活,延期愈合.术后随访6～24个月,肿瘤无复发,供区外观平整,瘢痕不明显,受区吞咽及言语功能良好,修复重建效果满意.结论 游离股前外侧穿支皮瓣制作方便,对供区损伤小,厚薄适中,适宜修复头颈肿瘤切除术后组织缺损.     

游离股前外侧皮瓣修复头颈肿瘤术后缺损

目的探索供区功能和外观损伤更小的游离股前外侧(anterolateralthigh,ALT)皮瓣修复技术,运用于头颈肿瘤术后缺损。方法2003年12月—2005年5月中国医科院肿瘤医院头颈外科用于头颈部手术缺损修复的游离股前外侧皮瓣8例。头颈部肿瘤手术缺损按受区部位分为口咽侧壁3例,舌活动部2例,颊黏膜、舌根和颅底各1例。结果8例游离ALT皮瓣手术均获成功。供区伤口一期愈合,未发现切口裂开,下肢运动和感觉功能障碍等手术并发症。8例皮瓣的穿支血管类型均为肌皮穿支,皮瓣应用面积为(4~8)cm×(5~10)cm。手术时间5~10h,平均7h。皮瓣切取制作时间65~115min,平均80min。结论游离股前外侧皮瓣具有修复技术可靠、供区部位隐蔽和并发症少等优点,是头颈部缺损修复的理想皮瓣之一。     

CTA联合数字化技术在头颈颌面部肿瘤术后缺损股前外侧皮瓣修复设计中的应用价值

目的:探讨计算机断层扫描血管造影术(CTA)联合数字化技术在头颈颌面部肿瘤术后缺损患者股前外侧皮瓣血管解剖及术前术中皮瓣设计中的价值.方法:选取我院2018年4月-2019年4月收治的25例头颈颌面部肿瘤术后缺损患者为研究对象,术前CTA、数字化技术明确血管解剖学等相关情况,实施手术,通过一致性分析CTA、数字化技术及...     

股前外侧皮瓣与前臂皮瓣修复口咽癌术后缺损的功能评价

目的:探讨股前外侧皮瓣与前臂皮瓣修复口咽鳞状细胞癌术后缺损的口咽功能恢复情况.方法:回顾性研究2016年9月-2020年9月在山西医科大学第一医院口腔科完成的37例口咽癌术后软组织缺损行股前外侧皮瓣或前臂皮瓣修复的患者资料,其中22例采用前臂皮瓣修复,15例采用股前外侧皮瓣修复,比较2组皮瓣制备成活率、血管危象发生率,...     

游离股前外侧皮瓣在下咽及颈段食管肿瘤切除后组织缺损修复中的应用

目的：探讨游离股前外侧皮瓣修复下咽及颈段食管肿瘤切除后组织缺损的方法和疗效。方法：对2例以游离股前外侧皮瓣修复肿瘤切除术后下咽及颈段食管组织缺损患者的临床资料进行回顾性分析。结果：2例患者均进行了下咽及颈段食管切除和重建，无围手术期死亡及皮瓣坏死；无术后咽瘘及食管狭窄发生；术后患者吞咽功能满意，均能进普食，并有较好的食管发声；分别随诊16及41个月，均无瘤生存。结论：游离股前外侧皮瓣修复下咽及颈段食管肿瘤切除术后缺损，成功率高，并发症少，功能恢复理想，是下咽及颈段食管组织缺损修复的理想皮瓣之一。     

Head and neck epithelioid sarcoma in a child: diagnostic dilemma and anterolateral thigh free flap reconstruction

The diagnostic dilemma is discussed of a child who presented with a granulomatous process of the external ear that was originally considered granuloma annulare and was later diagnosed as epithelioid sarcoma. We present the surgical treatment and the first report of reconstruction of a lateral skull base and cheek defect with an anterolateral thigh (ALT) free flap in a pediatric patient.     

Use of the anterolateral thigh flap for reconstruction of the head and neck

PURPOSE OF REVIEW: The anterolateral thigh free flap has achieved recent popularity in North America for the reconstruction of head and neck defects after ablative surgery. The flap is most often based on either the septocutaneous or musculocutaneous perforators of the descending branch of the lateral circumflex femoral artery. Its versatility allows for a subcutaneous, fasciocutaneous, myocutaneous, or adipofascial flap to be obtained. RECENT FINDINGS: Recent publications have described the utility of the anterolateral thigh flap for reconstruction of head and neck defects. It has been used successfully in the reconstruction of the laryngopharynx, oral cavity, oropharynx, external skin, and maxilla. Furthermore, when a thinner flap is needed, a suprafascial anterolateral thigh flap may be raised or the flap may be thinned after it is obtained. SUMMARY: The anterolateral thigh flap is a highly versatile and reliable flap for use in the reconstruction of various soft tissue defects of the head and neck. This flap has gained great popularity in mainland China, Taiwan, and Japan given its versatility, ability for a two-team approach, and minimal donor site morbidity. However, it has not met the same enthusiasm in Europe and North America because of the relative difficulty in perforator dissection, reported variations of the vascular anatomy, and the presumed increased thickness of the anterolateral thigh tissue in the Western population in comparison with the patient population of the Far East. These obstacles may be overcome by increased surgical experience and by the ability to create a thinner suprafascial flap or thinning the flap after it has been obtained.     

The role of the anterolateral thigh flap for pharyngoesophageal reconstruction

OBJECTIVE: To elucidate the advantages and disadvantages of the anterolateral thigh flap (ALTF) for pharyngoesophageal reconstruction, we assessed this donor site and compared it with the radial forearm free flap (RFFF). DESIGN: Retrospective medical chart review. SETTING: Tertiary care referral center. SUBJECTS: Twenty-three consecutive patients who underwent pharyngoesophageal reconstruction using an ALTF or RFFF. INTERVENTION: Pharyngoesophageal reconstruction. MAIN OUTCOME MEASURES: Patient medical charts were assessed for age, histopathological diagnosis, preoperative treatment, surgical defect, tracheoesophageal speech, flap survival, donor and recipient site complications, and swallowing function. RESULTS: Twenty-three patients (12 who underwent reconstruction with ALTF and 11 with RFFF) were included in the study. Both donor sites provided adequate tissue for pharyngoesophageal reconstruction; however, the RFFF group demonstrated a higher rate of postoperative donor site complications including skin graft loss and extremity edema and stiffness. Postoperatively, the ALTF group demonstrated no gait disturbance and no donor site complications. All 23 patients in both groups were able to tolerate an unrestricted oral diet; however, 3 patients who underwent reconstruction with an RFFF experienced cervical esophageal stenosis, whereas only 1 patient with an ALTF experienced stenosis. CONCLUSION: In this preliminary series, the ALTF represents an excellent source of tissue for pharyngoesophageal reconstruction and is associated with a lower rate of donor site morbidity and anastomotic stenosis compared with the RFFF donor site.     

游离股前外侧皮瓣在头颈外科中的应用

目的 总结应用游离股前外侧皮瓣修复头颈肿瘤术后缺损的临床经验.方法 回顾性分析2007年11月至2010年6月辽宁省肿瘤医院头颈外科应用游离股前外侧皮瓣修复重建头颈部恶性肿瘤术后缺损43例患者的临床资料.患者男32例,女11例;年龄40～81岁,中位年龄56岁.口腔癌23例,咽侧壁扁桃体7例,下咽癌11例,头皮癌、枕部肉瘤各1例.肿瘤分期:T1期9例,T2期17例,T3期11例,T4期6例.为保证有足够的安全切缘,所有患者手术切除范围为距肉眼所见肿瘤边缘至少2 cm,43例患者肿瘤切除术后应用游离股前外侧皮瓣进行修复重建,恢复咀嚼、吞咽及呼吸功能.皮瓣血管蒂长8～18 cm,平均12.5 cm.左股前外侧皮瓣41例,右侧2例.皮瓣面积(4～15)cm×(5～25)cm.结果 游离股前外侧皮瓣移植一期成功40例,1例术后第5天出现静脉血栓,重新吻合血管皮瓣成活.坏死3例,其中2例分别于术后第1天、第4天胸大肌肌皮瓣修复.1例第20天皮瓣坏死脱落后长肉芽愈合.11例下咽癌患者中3例行喉全切除术,8例保留喉功能(72.7%).23例口腔癌、7例咽侧壁扁桃体癌术后均恢复较好的咀嚼、吞咽、发音功能.头皮癌、枕部肉瘤患者较好地修复了大面积皮肤缺损.结论 游离股前外侧皮瓣修复技术可靠,成活率高,供区无严重并发症.皮瓣薄厚适中,可塑性好,是头颈肿瘤术后修复重建理想的修复皮瓣.

Abstract：

Objective To evaluate the results of reconstruction by free anterolateral thigh flaps ( ALT) after operation of head and neck tumors. Methods Forty-three cases underwent the reconstruction of postoperative defects with free anterolateral thigh flaps after head and neck cancer surgeries between November 2007 and June 2010 were reviewed. Ages of the patients ranged from 40 to 81 years, with a median of 56 years; 32 males and 11 females; 23 cases of oral carcinoma, 7 cases of tonsil carcinoma, 11 cases of hypopharyngeal carcinoma,and 2 cases of head skin cancer. TNM classified as follows; no case of distant metastasis; T1 9 cases; T2 17 cases; T3 11 cases; T4 6 cases. All patients were applied with ALT to restore swallowing and respiratory functions. The mean length of blood vessel pedicles of the ALT free flaps was 12. 5 (8-18) cm. The flaps were 4 - 15 cm in width,5 - 25 cm in length. Results In the 43 cases applied with ALT free flaps, 40 cases were successful and 3 cases unsuccessful. Two of the failed cases were reconstructed with pectoralis major flap. In 11 cases of hypopharyngeal carcinoma, except 3 cases with total laryngectomy, 8 cases(72. 7% ) had their laryngeal function been preserved. Conclusions The successful rate of ALT free flaps is perfect. There were no serious complication in offered areas. The flap could be shaped into various forms. ALT free flap is an ideal flap to reconstruct the defect after surgery in some head and neck tumors.     

Head and neck reconstruction with free flaps: a report on 213 cases

The aim of this retrospective study is to review the experience of our institution in performing microvascular head and neck reconstruction between 2000 and 2004. During this period, 213 free flaps, including 146 radial forearm free flaps, 60 fibular flaps and 7 scapular flaps, were performed. Free flap success rate and complications were reported. The pre-treatment factors influencing these results were subsequently analyzed. Functional and aesthetic outcomes were evaluated by the same clinician. There were 14 free flap failures, giving an overall free flap success rate of 93.4%. Salvage surgery for recurrent cancer was the only factor correlated with a higher risk of free flap failure (P = 0.0004). The local complication rate was 20.9%. High level of comorbidity (P = 0.009), salvage surgery for recurrent cancer (P = 0.03) and hypopharyngeal surgery (P = 0.002) were associated with a higher risk of local complications. An unrestricted oral diet and an intelligible speech were recovered by respectively 76 and 88% of the patients. Microvascular free flaps represent an essential and reliable technique for head neck reconstruction and allow satisfactory functional results.     

游离股前外侧穿支血管皮瓣修复上颌骨切除后缺损

目的探讨股前外侧穿支血管皮瓣简称股前外侧皮瓣（anterolateral thigh flap,ATF）,游离移植修复上颌骨切除后缺损的可行性及修复效果。方法回顾性分析18例上颌骨肿瘤患者的临床资料,上颌骨全切除术16例,上颌骨下部切除术2例。全部患者均用ATF I期修复。结果全部病例均移植成功,成功率100%,外形满意率为94%。恶性肿瘤17例,3年生存率为68.8%。结论 ATF可作为上颌骨切除术后修复材料,较好的恢复功能与外形。