个体化设计的股前外侧复合肌皮瓣修复舌癌根治术后舌及口底缺损

Objective To investigate the application of individualized free anterolateral thigh combined flap (ALTCF) for tongue and mouth floor defect resulted from tongue carcinoma. Methods From 2006 to 2008, individualized ALTCFs were used in 31 cases of tongue and mouth floor defects resulted from tongue carcinoma. The nutritional perforator vessel was musculocutaneous pattern in 22 cases and septocutaneous pattern in 9 cases. The size of the flaps and the included muscle was (4～8) cm×(5～10) cm and (2～5) cm × (3～ 6) cm, respectively. The length of blood vessel pediclc was (6.81±3.23) cm. Results All the 31 free flaps survived with primary healing and no complication. The appearance and function were both satisfactory. During the follow-up period of 1～3 years, 28 cases survived, 2 cases were reoperated due to the neck lymphatic metastais on the contralateral side. 1 case died of distant metastasis. Conclusions Individualized ALTCF is a reliable flap for the tongue and month floor defects resulted from tongue carcinoma. Both the cosmetic and functional results are satisfactory with less morbidity in donor site and less complication.     

腓骨头复合组织瓣修复儿童内踝骨皮肤缺损四例

Objective To investigate the therapeutic effect of fibular head composite flap for bone and skin defect at medial malleolus in children. Methods From Aug. 2005 to Apr. 2009, 4 children cases(2 male, 2 famale, from 3 to 11 year) with bone and skin defect at medial malleolus were reconstructed with fibular head composite flaps pedicled with lateral inferior genicular vascular bundle. The skin defect was 3- 6 cm × 8-10 cm in size. Results All the 4 compostie flaps survived completely. The patients were followed up for 4 months to 4 years with good bony healing. Both esthetic and functional results were satisfactory in ankle joint. Conclusions The fibular head composite tissue flap has a good therapeutic effect for bone and skin defect at medial malleolus in children.     

腓骨头复合组织瓣修复儿童内踝骨皮肤缺损四例

Objective To investigate the therapeutic effect of fibular head composite flap for bone and skin defect at medial malleolus in children. Methods From Aug. 2005 to Apr. 2009, 4 children cases(2 male, 2 famale, from 3 to 11 year) with bone and skin defect at medial malleolus were reconstructed with fibular head composite flaps pedicled with lateral inferior genicular vascular bundle. The skin defect was 3- 6 cm × 8-10 cm in size. Results All the 4 compostie flaps survived completely. The patients were followed up for 4 months to 4 years with good bony healing. Both esthetic and functional results were satisfactory in ankle joint. Conclusions The fibular head composite tissue flap has a good therapeutic effect for bone and skin defect at medial malleolus in children.     

股前外侧肌皮瓣修复足踝侧方组织缺损

Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.     

股前外侧肌皮瓣修复足踝侧方组织缺损

Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.     

含部分肌肉的纵行腹直肌肌皮瓣阴道形成术

Objective To evaluate the method for vaginal treconstruction with muscle sparing verti-cle rectus abdominis myocutaneous flap(MS-VRAM flap). Methods From September 2006 to April 2008, MS-VRAM flaps were used for vaginal reconstruction in 9 patients (20 to 35 years old), ancl all ca-ses were congenital absence of vagina. Before operation, the inferior epigastrie arteries were detected by the Doppler and the flaps based on the perforators ranged from 6 cm×20 cm. MS-VRAM flaps were ele-vated and then transferred to reconstruct the vagina. Results All 9 cases of MS-VRAM flaps survived completely. No complications occurred at donor site of abdominal wall. With 2-12 months' follow-up, the patients were satisfied with the results. Conclusion Despite technical difficulties in elevating the MS-VRAM flap, the flap is a good choice for vaginal reconstruction.     

含部分肌肉的纵行腹直肌肌皮瓣阴道形成术

Objective To evaluate the method for vaginal treconstruction with muscle sparing verti-cle rectus abdominis myocutaneous flap(MS-VRAM flap). Methods From September 2006 to April 2008, MS-VRAM flaps were used for vaginal reconstruction in 9 patients (20 to 35 years old), ancl all ca-ses were congenital absence of vagina. Before operation, the inferior epigastrie arteries were detected by the Doppler and the flaps based on the perforators ranged from 6 cm×20 cm. MS-VRAM flaps were ele-vated and then transferred to reconstruct the vagina. Results All 9 cases of MS-VRAM flaps survived completely. No complications occurred at donor site of abdominal wall. With 2-12 months' follow-up, the patients were satisfied with the results. Conclusion Despite technical difficulties in elevating the MS-VRAM flap, the flap is a good choice for vaginal reconstruction.     

含部分肌肉的纵行腹直肌肌皮瓣阴道形成术

Objective To evaluate the method for vaginal treconstruction with muscle sparing verti-cle rectus abdominis myocutaneous flap(MS-VRAM flap). Methods From September 2006 to April 2008, MS-VRAM flaps were used for vaginal reconstruction in 9 patients (20 to 35 years old), ancl all ca-ses were congenital absence of vagina. Before operation, the inferior epigastrie arteries were detected by the Doppler and the flaps based on the perforators ranged from 6 cm×20 cm. MS-VRAM flaps were ele-vated and then transferred to reconstruct the vagina. Results All 9 cases of MS-VRAM flaps survived completely. No complications occurred at donor site of abdominal wall. With 2-12 months' follow-up, the patients were satisfied with the results. Conclusion Despite technical difficulties in elevating the MS-VRAM flap, the flap is a good choice for vaginal reconstruction.     

含部分肌肉的纵行腹直肌肌皮瓣阴道形成术

Objective To evaluate the method for vaginal treconstruction with muscle sparing verti-cle rectus abdominis myocutaneous flap(MS-VRAM flap). Methods From September 2006 to April 2008, MS-VRAM flaps were used for vaginal reconstruction in 9 patients (20 to 35 years old), ancl all ca-ses were congenital absence of vagina. Before operation, the inferior epigastrie arteries were detected by the Doppler and the flaps based on the perforators ranged from 6 cm×20 cm. MS-VRAM flaps were ele-vated and then transferred to reconstruct the vagina. Results All 9 cases of MS-VRAM flaps survived completely. No complications occurred at donor site of abdominal wall. With 2-12 months' follow-up, the patients were satisfied with the results. Conclusion Despite technical difficulties in elevating the MS-VRAM flap, the flap is a good choice for vaginal reconstruction.     

含部分肌肉的纵行腹直肌肌皮瓣阴道形成术

Objective To evaluate the method for vaginal treconstruction with muscle sparing verti-cle rectus abdominis myocutaneous flap(MS-VRAM flap). Methods From September 2006 to April 2008, MS-VRAM flaps were used for vaginal reconstruction in 9 patients (20 to 35 years old), ancl all ca-ses were congenital absence of vagina. Before operation, the inferior epigastrie arteries were detected by the Doppler and the flaps based on the perforators ranged from 6 cm×20 cm. MS-VRAM flaps were ele-vated and then transferred to reconstruct the vagina. Results All 9 cases of MS-VRAM flaps survived completely. No complications occurred at donor site of abdominal wall. With 2-12 months' follow-up, the patients were satisfied with the results. Conclusion Despite technical difficulties in elevating the MS-VRAM flap, the flap is a good choice for vaginal reconstruction.     

个体化设计的股前外侧复合肌皮瓣修复舌癌根治术后舌及口底缺损

目的 探讨应用个体化设计的游离股前外侧复合肌皮瓣,修复舌癌根治术后舌及口底缺损的效果.方法 2006年至2008年应用个体化设计的游离股前外侧复合肌皮瓣,修复31例舌癌根治术后舌及口底缺损,22例皮瓣的穿支血管类型为肌皮穿支,9例为肌间隙穿支;皮瓣大小为(4～8)cm×(5～10)cm,所携带股外侧肌大小为(2～5)cm×(3～6)cm,血管蒂的长度为(6.81±3.23)cm.结果 31例游离股前外侧复合肌皮瓣手术均获成功,舌外形及功能恢复良好,口底及下颌下区饱满;受区及供区伤口一期愈合,未发现口底瘘、下肢运动和感觉功能障碍等并发症,经1～3年的随访,28例无瘤生存,外观及功能满意,2例因术后出现对侧颈淋巴结转移再次手术;1例术后因远处转移死亡.结论 个体化设计的游离股前外侧复合肌皮瓣具有可重建良好的舌及口底形态,恢复舌功能,供区部位隐蔽和并发症少等优点,是修复舌癌根治术后舌及口底缺损的理想的首选皮瓣.     

股前外侧皮瓣修复中晚期舌癌术后缺损

目的 报道应用股前外侧皮瓣移植修复中晚期舌癌术后缺损的临床效果.方法 对9例中晚期舌癌患者接受舌癌联合根治术同期应用吻合血管的股前外侧皮瓣移植修复术后缺损.皮瓣切取面积最大10 cm×12 cm,最小7 cm×10 cm,修复舌及口底缺损.术后随访评价再造舌形态、活动度、吞咽功能及语音功能.结果 9例患者供区均直接拉拢缝合,术后供受区伤口一期愈合,股前外侧皮瓣成活.术后平均随访18个月,肿瘤无复发,无严重并发症,再造舌外形较丰满,有一定的活动度,吞咽、语音功能恢复良好,供区瘢痕隐蔽,临床疗效满意.结论 股前外侧皮瓣移植修复中晚期舌癌术后缺损的临床效果满意,值得推广应用.     

游离股前外侧组织瓣修复全舌或近全舌切除术后组织缺损

目的探讨游离股前外侧组织瓣在全舌或近全舌切除术后组织缺损修复的治疗效果。方法2015年3月-2018年5月,收治15例舌癌(全舌或近全舌切除)患者,肿瘤根治术后应用股前外侧组织瓣同期修复,皮瓣大小为6 cm×10 cm^8 cm×15 cm,对其临床资料进行回顾性分析,术后要求患者定期到门诊复查。结果15例皮瓣均成活,术后发生血管危象1例,经探查及相应处理后完全成活。术后于门诊随访12~48个月,平均30个月,舌部受区皮瓣成活良好,术后6个月患者张口度、咀嚼功能恢复良好,但是吞咽及语音功能欠佳;大腿供区运动功能良好,无麻木、疼痛不适。结论全舌或近全舌切根治术后遗留的组织缺损,以游离股前外侧组织瓣进行修复重建,可以较好的恢复舌的部分功能及外形。     

带肋胸膜的肋骨-胸大肌复合瓣修复晚期舌癌根治术后缺损

目的探讨应用带肋胸膜的肋骨-胸大肌复合瓣联合修复晚期舌癌根治术后软硬组织大型缺损的临床效果和安全性。方法对6例累及同侧口底和下颌骨并越过中线的晚期舌癌患者实施舌颌颈联合根治术,开胸切取以胸肩峰动静脉为血管蒂的带肋胸膜的肋骨（第5肋）．胸大肌复合瓣即刻修复根治术导致的全舌、口底和下颌骨大型复合组织缺损,其中胸大肌肌皮瓣用以重建全舌和口底,肋骨瓣则用以修复患侧下颌骨。结果6例患者术后恢复良好。肋骨．胸大肌复合瓣全部成活,术后口腔、颈部和胸部创面均一期愈合。重建全舌、口底和面下部形态良好,上下颌咬合关系正常,下颌骨无偏斜,语言和吞咽功能基本恢复正常。结论带肋胸膜的肋骨．胸大肌复合瓣修复口腔颌面大型软硬组织缺损安全可靠,开胸切取肋胸膜不会导致患者术后胸廓运动和呼吸功能异常及其他胸肺部并发症,而且制备简便,带肋胸膜确保了肋骨-胸大肌复合瓣中肋骨的血运。     

舌癌连续整块切除血管化（肌）皮瓣修复重建术后的功能评价

目的评价舌癌连续整块切除同期行血管化（肌）皮瓣修复舌缺损后的语音、咀嚼功能。方法行手术治疗后6～18个月的舌癌患者共47例,其中行前臂皮瓣修复20例（前臂组,半舌以内14例,半舌以上16例）,股前外侧肌皮瓣修复27例（股前外侧组,半舌以内15例,半舌以上10例,全舌2例）。采用两因素两水平的析因设计与方差分析比较其语音和咀嚼效率;采用W ilcoxon秩和检验分析比较两个皮瓣组术后的舌颌沟深度改变值。结果与前臂皮瓣组比较,股前外侧组的舌颌沟深度改变值较小（P=0.000）,咀嚼效率较优（P=0.035）,但语音清晰度较低（P=0.006）。结论股前外侧皮瓣修复更有利于舌癌患者术后的咀嚼和进食,但前臂皮瓣短期内更有利于语音的恢复。     

应用胸大肌岛状肌皮瓣重建全舌体、口底的初步报告

目的 探讨累及双侧的舌癌根治术后全舌体、口底重建的有效方法及临床评价。方法 对2000年10月至2002年12月问我科收治的7例累及双侧的舌癌患者实施根治性手术，造成全舌体、口底的大面积缺损，采用一侧胸大肌岛状肌皮瓣转移即时重建全舌体和双侧口底。结果 6例转移肌皮瓣完全成活，口腔和颈、胸部创面均一期愈合。1例肌皮瓣远端部分皮肤坏死，但无口底颌下瘘和感染等并发症发生。术后随访2～16个月，重建舌体、口底形态基本满意，语言功能大部分恢复，吞咽功能恢复良好。1例在术后9个月死于肿瘤肺转移，其余6例目前均继在。结论 胸大肌岛状肌皮瓣组织量大，血供丰富，是全舌体、口底重建的理想选择。     

胸大肌肌皮瓣与钛板联合修复口腔癌根治术后的下颌骨缺损

目的探讨胸大肌肌皮瓣与钛板联合即刻修复口腔癌根治术后的下颌骨缺损的效果。方法2001年11月~2003年2月,对32例口腔癌根治术后下颌骨缺损患者,其中11例下颌牙龈癌行龈颌颈联合根治术,13例舌癌行舌颌颈联合根治术,4例口底癌行口底颌颈联合根治术,4例颊粘膜癌行颊颌颈联合根治术。术后遗留下颌骨缺损长度4~12 cm,邻近软组织缺损范围5.5 cm×7.6 cm~8.2 cm×10.5 cm,采用大小为6 cm×7 cm~9 cm×10 cm带蒂胸大肌肌皮瓣与钛板即刻修复。通过回顾性研究,分析其修复效果。结果术后肌皮瓣29例全部成活,3例有小部分皮岛坏死。均获随访2~19个月,27例面部外形基本满意,5例呈轻度不对称畸形;余留的上下颌牙咬牙合关系、咀嚼功能恢复良好;张口度2.7~3.4 cm;未出现与手术相关的颞颌关节疾病。结论胸大肌肌皮瓣与钛板联合应用是修复口腔癌根治术后伴较多软组织缺损和下颌骨节段性缺损较理想的方法。     

股薄肌皮瓣在修复舌癌术后缺损中的应用

目的:评价股薄肌皮瓣在舌癌术后缺损修复重建中的临床应用价值。方法:对7例舌癌患者在原发灶切除后利用股薄肌皮瓣行动力性舌再造,术后随访评价舌功能恢复情况。结果:7例股薄肌皮瓣均获得成功,再造舌外形丰满,运动良好,术后6个月均检测出不同程度的肌电信号,患者的言语、咀嚼、吞咽功能恢复满意。结论:股薄肌皮瓣位置表浅,供区隐蔽,血供稳定,容易塑形,可实现动力性舌再造,是修复舌癌术后缺损的一种较好选择。     

削薄股前外侧皮瓣游离移植修复舌癌术后缺损

目的探讨削薄游离股前外侧皮瓣修复舌癌术后缺损的效果。方法对2003年6月至2007年9月采用削薄游离股前外侧皮瓣同期修复舌癌术后组织缺损17例资料进行分析。结果17例游离皮瓣中，15例皮瓣全部成活，2例皮瓣远端近舌尖处部分坏死，1例腿部供区皮下积液，换药后痊愈。随访3个月-4年，舌功能良好，下肢无运动障碍。1例（T2N2M0）14个月后死亡，1例（T3N1M0）6个月后局部复发冉次手术。结论削薄股前外侧皮瓣游离移植，修复效果好，对供区影响小，是修复舌癌术后缺损较理想的方法。     

应用股前外侧肌皮瓣同期修复舌癌根治术后缺损的手术配合

【摘要】 目的 探讨应用股前外侧肌皮瓣同期修复舌癌根治术后缺损的手术配合,提供护理经验。方法〓对38例同期应用股前外侧肌皮瓣修复舌癌根治术后舌缺损实施术前、术中手术配合和护理。结果〓38例皮瓣均成活,其中1例皮瓣出现边缘坏死,经清创后二期愈合;修复后舌的外形和吞咽、语言功能得到较好地恢复。结论〓术前备齐所需物品,护士应熟悉手术步骤及术中配合,严格执行无菌和无瘤原则是手术成功关键。