去上皮逆行面动脉-颏下动脉颏下岛状瓣修复上颌术后缺损

目的：探讨去上皮逆行面动脉-颏下动脉颏下岛状瓣对上颌骨术后缺损的修复效果。方法：回顾性研究我科自2007年3月-2009年1月应用去上皮逆行面动脉-颏下动脉颏下岛状瓣修复上颌骨术后缺损病例13例。其中男9例。女4例。所有病例均经病理学检查确诊,其中10例诊断为上颌牙龈鳞状细胞癌,其余3例诊断为硬腭鳞状细胞癌。依据Brown等提出的上颌骨缺损分类法,术后缺损为2a型．用以同期修复的面动脉-颏下动脉岛状瓣长度约8～10cm．宽度约4～5cm。结果：面动脉-颏下动脉岛状瓣的存活率为92.3％（12／13）,未见供区并发症及面神经下颌缘支损伤。随访8～24个月．1例原发灶复发后死亡,2例颈淋巴结复发。结论：去上皮逆行面动脉-颏下动脉颏下岛状瓣具有安全、简单、易于改良等优点,适用于无区域性淋巴结转移的恶性肿瘤术后上颌骨缺损修复。     

逆行面动脉-颏下动脉岛状肌瓣修复良性肿瘤切除后面部畸形

目的:评价应用逆行面动脉-颏下动脉岛状肌瓣修复面部畸形的可行性。方法:应用逆行面动脉-颏下动脉菱形岛状肌瓣修复5例良性肿瘤切除后面部畸形。男1例,女4例,年龄29~36岁。面颊部和颞下部复发性多行性腺瘤4例,复发性基底细胞腺瘤1例。结果:5例患者均获得良好的效果,未发生皮瓣坏死和其他并发症。皮瓣受区外观满意,功能恢复良好,未出现供区并发症。经术后20~24个月随访,无一例复发。结论:逆行面动脉-颏下动脉岛状肌瓣安全可靠,制备简单快速,适合颊部、颞下部良性肿瘤切除后中上面部畸形的修复。     

应用面动脉-颏下动脉岛状肌皮瓣修复舌癌术后缺损

目的：探讨面动脉-颏下动脉岛状肌皮瓣同期修复舌癌术后缺损的效果。方法：2005年1月—2006年1月收治舌癌患者11例,其中男6例,女5例,全部采用面动脉-颏下动脉岛状皮瓣对舌癌根治性切除后半舌缺损进行同期整复,皮瓣最小8cm×3cm,最大12cm×4.5cm。结果：11例皮瓣全部存活,术后随访1a,未发现复发和转移。全部皮瓣形态、质地良好,面部外形满意。结论：面动脉-颏下动脉岛状皮瓣具有可靠血供,操作简便安全,适合同期修复T2期舌癌术后半舌缺损。     

Use of a folded reverse facial-submental artery submental island flap to reconstruct soft palate defects following cancer ablation

IntroductionAlthough several techniques have been described for the repair of soft palate defects, soft palate reconstruction remains challenging. This study was performed to evaluate swallowing and speech functions in patients undergoing placement of folded reverse facial-submental artery submental island flaps (FRFF) to reconstruct soft palate defects following cancer ablation.Materials and methodsFRFFs were designed for eight patients with soft palate defects resulting from soft palatal squamous cell carcinoma ablation. The clinical stages of tumours were I in two patients, II in four patients, and III in two patients. FRFFs were created to reconstruct soft palate defects. Swallowing and speech functions were evaluated 3 months postoperatively.ResultsOne minor flap failure occurred, but all flaps survived. No donor-site problem occurred. Five patients managed ingestion of a solid diet, two managed a soft diet, and one remained on a liquid diet. Six patients achieved normal speech, one achieved intelligible speech, and one retained slurred speech. The patients were followed for 8–48 months; seven patients were living with no evidence of disease, and one was living with disease.ConclusionsThe FRFF is reliable for soft palate defect reconstruction following cancer ablation and can achieve satisfactory swallowing and speech functions.     

颏下区岛状肌皮瓣在口腔颌面部软组织缺损重建中的应用

目的:探讨颏下区岛状肌皮瓣在口腔颌面部软组织缺损重建中的临床应用效果.方法:以颌外动脉、面前静脉的分支颏下动、静脉为蒂制备颏下区岛状肌皮瓣,修复口腔颌面部软组织缺损.结果:应用该皮瓣修复的14例患者,12例全部成活,1例出现部分坏死,1例失败,成功率92.9%,全部病例切除原发灶同时行同侧颈淋巴结清扫术,术后外观与功能满意.结论:颏下岛状皮瓣具有长而可靠的血管蒂、厚薄适中、成活率高、切口隐蔽、无需血管吻合、操作简单等优点,是口腔颌面部软组织缺损一期重建的理想选择.     

应用颏下岛状皮瓣修复24例早期口腔癌术后缺损疗效评价

目的： 评价应用颏下岛状皮瓣修复早期舌、颊、牙龈癌术后组织缺损的疗效。方法： 选择2014年11月—2017年8月收治的24例早期口腔癌患者,其中舌癌16例,牙龈癌5例,颊癌3例。患侧行肩胛舌骨上颈淋巴清扫术后,扩大切除病灶,同期应用3 cm×4 cm～5 cm×7 cm颏下岛状皮瓣修复组织缺损,对皮瓣成活、肿瘤复发、患者生存时间与生存质量进行评价。结果： 23/24例皮瓣成活,成活率为96%。术后随访3～30个月,1例牙龈癌局部复发,复发率为4%;2例舌癌远期颈部淋巴结转移,发生率为8%。患者言语、进食基本正常,对口腔形态及功能比较满意,随访期内未发生死亡病例。结论： 传统带蒂颏下岛状皮瓣制备简单,成活率高,手术创伤小,术后护理容易,是修复早期舌、颊、牙龈癌术后缺损的一种比较安全、可靠的方式。     

颏下岛状皮瓣在口咽癌术后缺损修复中的应用

目的:探讨颏下岛状皮瓣修复口咽癌术后缺损的临床效果,为临床应用提供经验。方法:选择口咽癌患者13例,其中鳞状细胞癌12例,肌上皮癌1例,行原发灶切除术及颈淋巴清扫术,采用颏下岛状皮瓣修复术后缺损。结果:13例患者中,12例皮瓣全部成活,1例皮瓣远心端坏死,经修剪换药后愈合,术后随访3个月～3 a,未见原发灶复发及颈部淋巴结转移,均获得良好的进食、语言功能。结论:颏下岛状皮瓣毗邻口咽区,供区位于颈淋巴清扫切口线,操作简单、方便。口咽癌I区淋巴结转移较少,用于修复口咽术后中小组织缺损安全有效,具有良好的临床应用价值。     

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。     

Reverse facial–submental artery island flap for reconstruction of oropharyngeal defects following middle and advanced-stage carcinoma ablation

To assess the reliability of the reverse facial–submental artery island flap for reconstruction of oropharyngeal defects after resection of intermediate stage and advanced carcinomas, we studied 13 patients with stage III and IV squamous cell carcinoma (SCC) of the oropharynx. They had all had their tumours excised followed by reconstruction of the oropharyngeal defect using a facial–submental artery island flap. There was no major failure of a flap, but two minor ones. The marginal mandibular branch of the facial nerve remained intact and undamaged. All donor sites healed well and scars were well-hidden. The functional results of speech and swallowing after 10–28 months’ follow-up were satisfactory. One patient developed lung metastases. The facial–submental artery island flap is a simple, reliable flap that can be used for reconstructing oropharyngeal defects after resection of medium and advanced carcinomas of the oropharynx.     

逆行面动脉-颏下动脉下颌骨肌瓣修复上颌骨Brown 2A型缺损

目的：评价逆行面动脉-颏下动脉下颌骨肌瓣修复Brown 2A型上颌骨缺损的可靠性。方法：以逆行面动脉一颏下动脉下颌骨肌瓣修复8例因切除良性肿瘤造成的上颌骨缺损。男5例,女3例,年龄16～33岁。其中,上颌骨牙源性黏液瘤3例,上颌骨骨纤维异常增殖症和成釉细胞瘤各2例,软骨黏液样纤维瘤1例。结果：应用逆行面动脉一颏下动脉下颌骨肌瓣同期修复Brown 2A型上颌骨缺损,所有骨肌瓣均成活,未出现供区并发症,所有患者均获得良好美观效果及功能恢复。随访12～24个月,平均18．6个月,肿瘤均无复发。结论：逆行面动脉-颏下动脉下颌骨肌瓣修复上颌骨缺损快速、简单、安全可靠。     

Submental artery island flap in intraoral reconstruction: A review

BackgroundThe submental flap was first introduced 20 years ago (1993). Advances in techniques and new findings from anatomic studies expanded the indications and improved the flap characteristics. Indications, limitation, and all possible variants of this flap are discussed comprehensively in this article.Materials and methodsA literature review was performed. We paid attention to the anatomy of submental region, and especially to submental artery and vein, muscles and lymphatics. Surgical techniques for each possible variant of this flap and examples of each situation are presented. Indications of submental flap for facial, oesophageal, pharyngeal, laryngeal, and oral cavity reconstruction were assessed.ResultsNinety studies meeting the inclusion criteria were reviewed. Classification of the submental flap based on skin paddle composition and blood supply is presented. Major modifications such as pedicled, free, and perforator flaps are discussed comprehensively and minor variants of submental flap such as bipaddled, bipedicled, expanded, deepithelialized, and interposition submental flaps are discussed, briefly. A historical look at this topic is presented to show how and by whom advances in submental flap were done.ConclusionThe submental flap has a wide arc of rotation; it is easy to rise and has low donor site morbidity. It is a safe, simple, and predictable method for reconstruction of oral cavity.     

Assessment of surgical outcomes and oncological safety for submental artery perforator flap reconstruction after ablation of oral cancer

The submental artery perforator flap (SAPF) has been a new option for the intraoral reconstruction of oral squamous cell carcinoma (OSCC) patients in recent years, but its surgical outcomes have not been well assessed. We compared the surgical outcomes and oncological safety of SAPF reconstruction for medium-sized soft-tissue defects after the ablation of primary oral cancer with traditional submental island flaps (SIF) and anterolateral thigh perforator flaps (ALTPF). Fifty-one SAPFs, 30 SIF, and 74 ALTPF were reviewed for the intraoral medium-sized reconstructions after the ablation of oral cancer from our institutional clinical oncological databases. We performed comparative assessments on the variables of surgical outcome and oncological safety among the 3 cohorts. A Kaplan-Meier estimate of survival for each flap was calculated. Operating time was significantly reduced in the SIF and SAPF groups than ALTPF (p = 0.021 and 0.014, respectively). Flap thickness of SAPF was the significantly thinnest (mean 0.5 cm) among three groups. The common complications of donor site for both SAPF and SIF group were incision dehiscence and orocutaneous fistula. There was no significant difference in disease-free survival (DFS) among the 3 groups. However, several OSCC patients with the SIF reconstruction were found to have recurrences with a metastatic lymph node under the flap after the first operation. SAPF could be a versatile choice of the intraoral reconstruction for the medium-sized soft-tissue defects after the ablation of oral cancer.     

面动脉-颏下动脉肌皮瓣修复腭部恶性肿瘤术后组织缺损的临床评价

目的:评价面动脉-颏下动脉肌皮瓣修复口腔腭部恶性肿瘤术后组织缺损的临床效果。方法 :2008-01—2010-09,采用面动脉-颏下动脉供血的岛状肌皮瓣修复腭部恶性肿瘤术后组织缺损共13例,其中男性7例,女性6例,年龄21⁷5岁,平均年龄56岁。病理类型:高分化鳞癌7例,中分化鳞癌2例,黏液表皮样癌3例,腺样囊性癌1例。TNM分期:T1N0M0 4例,T2N0M0 6例,T3N0M0 3例。皮瓣大小为(6 cm×4 cm)75岁,平均年龄56岁。病理类型:高分化鳞癌7例,中分化鳞癌2例,黏液表皮样癌3例,腺样囊性癌1例。TNM分期:T1N0M0 4例,T2N0M0 6例,T3N0M0 3例。皮瓣大小为(6 cm×4 cm)^{(12 cm×5 cm)}。其中8例为腭部洞穿性缺损,5例缺损鼻腔侧黏膜尚完整。结果:13例面动脉-颏下动脉供血的岛状肌皮瓣全部成活,患者腭部、颈部创面均一期愈合,腭部缺损修复形态良好。语音、咀嚼、吞咽功能恢复良好,无张口受限、头部后仰受限及面瘫等继发功能障碍,颌面部无明显畸形。3例腭部洞穿性缺损修复患者术后初期出现鼻塞症状,3个月后症状逐渐缓解。术后随访2(12 cm×5 cm)。其中8例为腭部洞穿性缺损,5例缺损鼻腔侧黏膜尚完整。结果:13例面动脉-颏下动脉供血的岛状肌皮瓣全部成活,患者腭部、颈部创面均一期愈合,腭部缺损修复形态良好。语音、咀嚼、吞咽功能恢复良好,无张口受限、头部后仰受限及面瘫等继发功能障碍,颌面部无明显畸形。3例腭部洞穿性缺损修复患者术后初期出现鼻塞症状,3个月后症状逐渐缓解。术后随访2³年,未见肿瘤复发及转移。结论:面动脉-颏下动脉供血的颏下岛状肌皮瓣血供明确可靠、制备方便,适宜修复腭部恶性肿瘤术后的组织缺损。     

Reconstruction of intraoral defects after resection of cancer with two types of submental artery perforator flaps

The submental island flap is a common choice for reconstruction of intraoral defects. To obtain a thinner, more pliable flap and get a better oncological result, the submental artery perforator flap has been proposed, and to assess its feasibility for closure of defects after resection of cancers of the oral cavity we studied 20 patients, each of whom was treated in this way. All the flaps were classified into those with septocutaneous perforators (n = 16) and those with musculocutaneous perforators (n = 4), and the main veins that drained the flaps were two submental veins (n = 17). There were two patterns of venous drainage: in pattern 1 (n = 9) the external jugular vein provided the primary venous drainage, and in pattern 2, the submental veins drained mainly into the facial vein, the common facial vein, and the internal jugular (n = 10). In one patient the submental veins bypassed the facial vein to drain into the internal jugular. Eighteen of the 20 patients had no postoperative complications. The remaining two developed mild venous congestion of the flaps, which was resolved with conservative management and no skin loss. No local or regional recurrence was detected after a mean (range) follow-up of 21 (4-35) months. This is a simple, reliable flap that can be used for the reconstruction of intraoral defects after resections for cancer, but its oncological outcome still requires proof in long-term, large-scale, clinical trials.     

颏下岛状瓣修复颊部肿瘤切除后组织缺损

目的：临床评价颏下岛状瓣修复颊黏膜组织缺损的应用价值。方法：10例颊黏膜、牙龈部位恶性肿瘤，扩大切除后形成的组织缺损以颏下岛状瓣修复，观察组织瓣存活情况及其修复效果。结果：颏下岛状瓣全部成活，未发生感染、坏死。保留全下颌骨者蒂部经过的部位表现丰满；2例瓣上胡须生长，其中1例诉说胡须引起局部不适。结论：颏下岛状瓣是一种修复颊部组织缺损的优良方法。     

面-颏下动脉岛状瓣在口腔颌面部缺损修复中的应用

面?颏下动脉岛状皮瓣(facial?submentalarteryislandflap,FSAIF)是由面动脉?颏下动脉供血的筋膜皮瓣,其与口腔颌面部缺损区相邻,其质地、色泽与头面部相似,该瓣血供恒定且血运充分,制备较简单,成活率高,并发症少。根据所携带的组织,FSAIF可分为筋膜皮瓣、肌皮瓣、单纯皮瓣等,该瓣还可制备成带下颌骨的骨筋膜(肌)皮瓣,修复上颌骨缺损。由于其为带蒂瓣,能够大大缩短手术时间、卧床制动时间和住院时间,已被广泛应用于口腔颌面中型缺损修复。医师在使用FSAIF修复口腔颌面部缺损中应严格把握适应证,口腔颌面部良性肿瘤或恶性肿瘤未发生颈淋巴结转移者可安全使用;对于口腔颌面部恶性肿瘤发生颈淋巴结转移但无淋巴结外扩展者,在颈淋巴清扫彻底的前提下可使用该皮瓣。FSAIF修复禁忌证为口腔颌面部恶性肿瘤发生颈淋巴结转移且有淋巴结外扩展,此时,应选择其他组织瓣修复。     

面动脉-颏下动脉岛状肌皮瓣修复颊黏膜缺损（附13例报告）

目的：评价面动脉-颏下动脉岛状肌皮瓣（FSF）修复颊癌术后颊黏膜缺损的临床效果。方法：13例颊黏膜鳞状细胞癌手术切除后颊黏膜组织缺损,用FSF修复。本组病例中,男8例,女5例;平均年龄58.5岁;T2N0M0期7例,T3N0M0期6例。皮瓣大小为4.0 cm×8.0 cm～5.0 cm×10.0 cm。结果：面动脉-颏下动脉岛状肌皮瓣修复颊黏膜缺损手术成功率92.3%（12/13）。全部病例经12～24个月复查,受区功能正常,供区外形良好,有1例颈部肿瘤复发。结论：FSF适用于修复中型颊黏膜缺损。     

The submental island flap: Pedicle elongation and indications in head and neck reconstruction

BackgroundThe submental island flap is an axial pattern skin flap first described by Martin et al. in 1993. When used to reconstruct skin defects it matches the recipient site in terms of colour, texture and thickness. One of the main limitations to its application is the arc of the pedicle allowing coverage of only the lower two thirds of the face.MethodsA retrospective review was performed of all patients who had had a submental island flap reconstruction at the Operative Unit of Maxillo-Facial Surgery of the University Hospital of Parma, Italy, between 2001 and 2011.The Authors focused on the surgical technique adopted, the clinical indications and the results obtained. They analysed the different ways to elongate the pedicle and discuss their thoughts on the choice of reconstruction. A flowchart was created to help in the decisional process.ResultsBetween 2001 and 2011 the submental island flap was used to reconstruct head and neck defects in 22 patients. Thirteen patients had defects of the oral cavity; the remaining 9 patients had skin defects involving the pre-auricular region, the temporal area and the peri-nasal cheek skin.No major complications occurred and in one case a partial necrosis of the distal portion of the flap was observed. Five patients underwent surgical revision involving intraoral flap debulking 6–10 months after the primary procedure.Discussion and conclusionsThe techniques to elongate the pedicle used and described were: additional dissection of the pedicle, Y–V procedure, reverse flow flap, section of facial vein and microvascular anastomosis. Their choice is mainly conditioned by the site of the defect.     

逆行面动脉-颏下动脉岛状肌皮瓣修复口腔颌面部缺损的探讨

目的评价逆行面动脉-颏下动脉岛状肌皮瓣修复口腔颌面部缺损的可行性。方法用逆行面动脉-颏下动脉岛状肌皮瓣修复18例恶性肿瘤切除术后口腔颌面部缺损。男性11例，女性7例，年龄28～90岁。舌鳞癌7例、颊黏膜鳞癌4例、腭鳞癌3例、口咽癌和面部皮肤基底细胞癌各2例。肌皮瓣面积最小为4．0cm×12．0cm，最大为5．0cm×15．0cm。结果17例肌皮瓣存活，1例缺血坏死。肌皮瓣受区外观满意、功能恢复良好，供区瘢痕隐蔽。经术后6～18个月，平均11．8个月随访，1例术后10个月对侧颈部淋巴结转移。结论逆行面动脉-颏下动脉岛状肌皮瓣是口腔颌面部中型缺损的理想修复材料。