应用游离腓骨组织瓣修复口腔肿瘤切除后下颌骨缺损

目的探讨应用游离腓骨组织瓣修复口腔肿瘤切除后下颌骨缺损的临床疗效。方法回顾分析接受游离腓骨组织瓣修复口腔肿瘤切除后下颌骨缺损的临床资料15例。其中下颌骨造釉细胞瘤5例，下颌骨纤维肉瘤2例。颌下腺腺样囊性癌3例，颌下腺粘液表皮样癌2例，口底黏膜高分化鳞癌3例。单纯腓骨骨瓣修复10例，腓骨骨皮瓣修复5例。结果14例腓骨瓣成活，生长良好，1例腓骨骨皮瓣因术后发生血循环危象，经抢救无效而坏死。结论游离腓骨组织瓣修复口腔肿瘤切除后下颌骨缺损可较好地恢复容貌和口腔功能，提高了患者的生存质量。     

改良鼻唇沟岛状皮瓣修复口腔鳞癌切除后软组织缺损

目的:探讨改良鼻唇沟岛状皮瓣在修复口腔颌面部缺损的临床效果。方法:选取2016年7月-2018年9月西南医科大学附属医院口腔颌面外科收治的8例口腔颌面部肿瘤切除术后软组织缺损患者。制备以面动静脉为蒂(血管蒂分离至颈外动静脉起始处),根据缺损情况切取岛状鼻唇沟皮瓣。完整切除病变后皮瓣从下颌骨内侧或者外侧转移修复缺损。术后观察皮瓣存活、供瓣区及受区伤口愈合情况,并对患者面部器官外形及功能进行3~24个月的术后随访。结果:8例患者皮瓣全部存活,血运良好。术后随访未出现肿瘤复发,面部器官外形基本正常,功能良好。结论:改良鼻唇沟岛状皮瓣具有操作简单、血供可靠、转移灵活,可同期修复同侧舌、口咽侧壁、口底、牙龈肿瘤切除后缺损,对不适宜行吻合血管游离组织瓣移植患者是理想的选择,值得临床推广应用。     

多种区域组织瓣在口腔颌面部缺损修复中的应用分析

目的:寻找口腔颌面部缺损的理想修复方法。方法:对97例口腔颌面部缺损,根据缺损部位、性质、范围,分别采用鼻唇沟皮瓣(6例),邻位滑行皮瓣(13例),Abbe瓣(4例),胸大肌肌皮瓣(17例),颈阔肌肌皮瓣(14例),下斜方肌肌皮瓣(4例),前臂皮瓣(13例),额瓣(6例),颞肌筋膜瓣修复(6例),舌瓣(11例),腓骨肌皮瓣(3例),观察修复效果。结果:97例区域组织瓣中,胸大肌肌皮瓣坏死1例,下斜方肌肌皮瓣尖端坏死1例,另1例胸大肌皮瓣术后放疗后坏死(术后4月),其余皮瓣存活,外形基本满意。所有患者均能进食,97%能正常饮食(食饭),其余可流质饮食。舌、腭、咽、口底肿物T3以上,术后语音轻度影响。结论:采用以上多种区域组织瓣修复口腔颌面部缺损,建议应尽可能采用邻近带蒂皮瓣;对于较大缺损修复主要是修复组织缺损,采用不同组织修复缺损,对进食、语音影响似区别不大,日后尚需作深入研究。     

面动静脉蒂鼻唇沟肌皮瓣一期修复联合根治术后口腔内缺损

在行口腔癌扩大切除并全颈淋巴清扫的联合根治术中，取鼻唇沟肌皮瓣并仅以面动脉与面前静脉为蒂，于颈淋巴清扫的同时将血管蒂从淋巴组织中解剖游离出来，完成肿瘤切除后再用该瓣修复口腔内缺损。临床用于修复口腔内组织缺损１５例，均为鳞状细胞癌，其中舌体８例，口底５例，舌侧牙龈２例。术后皮瓣全部成活，２例尖端部分坏死，经随访６个月～３年，无肿瘤复发。认为，保留面动静脉血管干从一定意义上说也是根治性颈淋巴清扫的一种改良术式，依此设计的鼻唇沟岛状肌皮瓣对于口腔恶性肿瘤根治术后缺损的修复具有一定的临床价值     

颈部带蒂组织瓣修复口腔颌面部肿瘤切除术后软组织缺损

目的介绍4种颈部带蒂组织瓣修复口腔颌面部肿瘤切除术后软组织缺损的方法。方法1982年1月~2003年12月,172例口腔颌面部肿瘤,其中口腔黏膜鳞癌165例,唾液腺癌7例。I期21例,Ⅱ期116例,Ⅲ期35例。病变主要部位:舌59例、颊黏膜55例、下颌牙龈26例、口底25例、腮腺4例及口咽区3例。肿瘤切除术与颈淋巴结清扫术后,应用颈阔肌皮瓣修复45例,胸锁乳突肌皮瓣修复59例,舌骨下肌皮瓣修复60例,颏下岛状瓣修复8例;切取肌皮瓣皮岛范围2.5 cm×5.0 cm~5.0 cm×8.0 cm。结果术后153例皮瓣全部成活,其中舌骨下肌皮瓣55例,颈阔肌皮瓣40例,胸锁乳突肌皮瓣52例,颏下岛状瓣6例;完全坏死11例,部分(皮岛1/4~1/2)坏死8例。4种皮瓣成功率分别为91.67%、88.89%、88.14%和75%。101例获随访3~11年,平均5.7年,原位复发18例,颈部复发4例,远处转移2例;3年生存84例,占83.17%。结论颈部带蒂组织瓣适用于修复口腔颌面部肿瘤切除后中小型软组织缺损。     

口腔颌面部缺损的修复重建--1 973例临床分析

目的 口腔颌面部缺损游离组织瓣修复方式的对比研究。方法 2001年1月～2004年6月，收集修复重建患者共1973例，分别对其年龄、性别、病种、缺损部位和修复类型的分布情况，游离组织瓣危象的发生率及成功率进行分类统计。采用SAS6．12医用统计软件包进行数据分析。结果 中年（〉45～≤60岁）患者764例，占38.72％；老年（〉60岁）527例，占26．71％；青壮年（〉28～≤45岁）450例，占22．81％；青年（〉14≤28岁）187例，占9．48％，儿童（≤14岁）45例，占2．28％。男1193例，女780例，男、女之比为1．5：1。良、恶性病变之比为1：1．94。缺损部位依次为舌20．63％、下颌骨17．38％、腮腺13．74％、颊12．72％、上颌骨8．16％、口咽7．60％、口底5.68％、其他占14．09％。血管化游离组织瓣修复904例，占45．82％；带蒂组织瓣753例，占38．17％；随意（皮）瓣201例，占10．19％；非血管化骨移植30例，占1．52％；其它方法85例，占4．30％。其中游离前臂皮瓣594例，腓骨肌（皮）瓣143例，带蒂胸大肌（皮）瓣369例，3种组织瓣共1106例，占修复重建总例数的56．06％。游离组织瓣共940个，发生术后危象47个（5．20％），抢救成功30个（63．83％），游离组织瓣总成功率为98．19％。结论 口腔颌面部缺损修复重建患者以中老年、男性、恶性肿瘤为主；舌的缺损修复约占1／5；游离组织瓣的成功率高，是主要的修复方式；前臂皮瓣、腓骨肌（皮）瓣、带蒂胸大肌（皮）瓣成为口腔颌面部缺损修复的常用组织瓣。     

颜面体表肿瘤切除缺损的即期修复

目的 探讨面部体表肿瘤手术切除后缺损修复方法及效果.方法 均采用手术切除方法,治疗修复26例颜面部体表肿瘤.后遗缺损经局部松解不能直接闭合,根据部位,缺损大小设计以下邻近皮瓣或岛状皮瓣修复:V-Y滑行瓣12;颏下岛状皮瓣3块;眼睑轮匝肌皮瓣3块;眶上血管肌皮穿支瓣3块;颞浅额前支血管蒂岛状皮瓣2块;耳前窄蒂侧颌颈皮瓣3块.结果 自2000年2月～2006年6月,本组临床治疗26例,除2例皮瓣远端有少量表皮脱落,经换药愈合外,余例皮瓣均完全成活,伤口一期愈合,术后接受放疗4例.随访2个月～5年,肿瘤无复发,且皮瓣切口大都选择在面侧部、发际、鼻唇沟等顺皮纹处,外观无明显影响,功能外形恢复满意.结论 根据面部外形解剖特点,采用带血管蒂或皮下组织蒂邻近皮瓣或皮肤筋膜窄蒂皮瓣是修复颜面部体表肿瘤切除后缺损简便、高效的方法.     

口腔颌面部恶性肿瘤术后广泛缺损的修复

报道１９８５年￣１９９３年，用带蒂胸大肌皮瓣即刻修复口腔颌面部恶性肿瘤切除术后广泛组织缺损２１例临床经验。对胸大肌瓣的应用价值以及皮瓣的设计、制备、转移和预防皮瓣坏死的措施等进行了讨论。认为，胸大肌瓣是修复口腔颌面部广泛组织缺损的良好的组织瓣。     

应用显微外科技术修复小腿远端皮肤组织缺损

目的 报道应用带蒂逆行皮瓣、肌皮瓣及吻合血管游离皮瓣、肌皮瓣修复小腿远端1／3皮肤组织缺损的治疗临床效果。方法 临床应用61例，分别为急诊、延期、Ⅱ期应用5种带蒂逆行皮瓣、肌皮瓣修复小腿远端1／3皮肤组织缺损及延期、Ⅱ期应用2种吻合血管游离皮瓣或肌皮瓣修复小腿远端1／3大面积的皮肤组织缺损。结果 有2例吻合血管游离皮瓣移植，术后出现血管危象，经手术探查而成活，2例带蒂肌瓣出现远端部分坏死，经换药而愈。其余病例均全部成活。本组病例的肢体功能大部分恢复，外形满意。结论 应用显微外科方法修复小腿远端1／3皮肤组织缺损是安全、简便的方法，可获得良好的临床效果。     

小腿部带蒂肌瓣修复下肢远端软组织缺损

目的 报道小腿部带蒂皮瓣修复下胶远端软组织缺损的临床效果。方法 应用小腿带蒂肌瓣，同时游离植皮治疗下胶远端骨外露、骨坏死、骨髓炎、外伤性骨缺损、深度烧伤软组织缺损共32例。结果 30例肌瓣成活，1例肌瓣坏死，1例部分坏死，随访1～6年，小腿部带蒂肌瓣对修复组织薄弱，血运较差的下胶远端组织缺损效果良好。结论 小腿部带蒂肌瓣修复下胶远端软组织缺损切取方便、简单、成功率高。带蒂肌瓣血循环丰富，抗感染能力强。肌瓣切取后下胶功能与外形影响小，是下胶远端软组织缺损修复可供选择的一种较为理想的方法。     

腓骨瓣联合小腿外侧皮瓣修复颌面缺损

目的 探讨腓骨瓣联合小腿外侧皮瓣修复口腔颌面软、硬组织缺损的临床疗效.方法 以腓动、静脉为血管蒂腓骨瓣联合小腿外侧皮瓣进行颌面部软、硬组织缺损修复,腓骨用于修复颌骨缺损,小腿外侧皮瓣主要用于修复口底、牙龈、咽侧、颊以及腭部的软组织缺损.结果 2005年3月至2007年3月,共治疗26例,其中修复恶性肿瘤术后缺损25例,双侧上颌骨缺失1例.术中组织瓣制备顺利,没有出现伤及腓骨血管以及小腿外侧皮瓣的穿支血管的现象.所有移植组织瓣全部成活.其中有1例术后12 h出现吻合动脉危象,经抢救成活;1例术后24 h出现静脉吻合危象,静脉血栓形成,经手术探查,重新吻合静脉后,抢救成功.术后随访6个月至2年,修复区外形满意,患者能从事正常的社会活动.结论 腓骨瓣联合小腿外侧皮瓣修复口腔颌面部复合组织缺损效果较好.可作为首选方法.     

The pedicled lateral forehead flap in reconstructing oral floor defect - The last resort; case report

Introduction and importanceLocoregional flaps, particularly the pedicled lateral forehead flap, are not usually used in reconstructing oral floor defects following oncologic resection. Rather, microscopic free flaps have evolved to be the standard of care in head and neck reconstruction. However, the pedicled lateral forehead flap could be valuable in floor of the mouth reconstruction in the absence of resources or other options.Case presentationA-56 years old lady with multiple comorbidities who underwent near total glossectomy, bilateral supraomohyoid neck dissection, and right lateral mandibulotomy due to a locally advanced lingual squamous carcinoma. The last resort was the pedicled lateral forehead flap after many unsuccessful reconstructive attempts utilizing the free anterolateral flap, free radial forearm flap, and pedicled pectoralis major flap.Clinical discussionDecreased donor site morbidity and reliable anatomy are among many of the advantages that made free flaps favorable over locoregional pedicled flaps, especially in oral cavity defects coverage. Of the latter, the pedicled forehead flap, rich in vascularity and neighboring the oropharyngeal defects, could be used with different techniques and modifications. Close monitoring and patient condition optimization is required.ConclusionChoosing a particular reconstructive option should be done considering the available resources and expertise and the patient's condition. The pedicled forehead flap remains valuable when other options are inappropriate or have failed.     

Further experience with adipofascial ALT flap for oral cavity reconstruction

BACKGROUND: The restoration of the buccal mucosa is the main challenge for the plastic surgeon. In the past 15 years the free radial forearm flap has been widely used, due to its thickness and pliability. More recently, the anterolateral thigh free flap has become the customary flap in oral cavity reconstruction. METHODS: Six patients affected by oral cavity tumours underwent microsurgical reconstruction with the adipofascial anterolateral thigh free flap between December 2005 and December 2006. RESULTS: One flap was lost due to venous thrombosis. In the other five flaps the postoperative period was uneventful. The patients are still free from disease. Multiple biopsies were performed to compare the neo-mucosa with the native. No relevant differences have emerged. CONCLUSIONS: Replacing tissue with like tissue should be the surgeon's aim. In the authors' opinion, the adipofascial variation of the anterolateral thigh free flap is the ideal replacement for oral cavity mucosa, allowing good fixation and mobility, and optimum aesthetic and functional results. It can be thinned to fit the defect with low risk. The patching condition resulting from fasciocutaneous flaps reconstruction is avoided. The remucosalisation of the flap occurs in about 1 month for the neo-mucosal functions as it does in the native tissue. It is non-hair bearing and is not influenced by postoperative radiotherapy.     

Twelve-year experience in mandibular reconstruction using osteo-muscular dorsal scapular pedicled flaps

Primary mandibular reconstruction after tumor removal or osteoradionecrosis treatment is a standard procedure. The most common reconstruction techniques are fibula, scapula, and iliac crest free flaps. Nevertheless, all patients are not eligible for microsurgery.In this study, we assess 12 years of mandibular reconstruction using an osteo-muscular dorsal scapular pedicled flap (OMDS). We included 40 patients operated on using an OMDS flap. We collected parameters such as length of hospital stay, recurrence risk, and need for secondary flap for oral cutaneous fistula (OCF) treatment. Flap bone volume was assessed by segmenting the scapula on postoperative CT-scans using dedicated software.Forty patients were included. Indications for OMDS flaps were severe cardiovascular history (27%), preoperative radiotherapy with a radiation neck and potentially unreliable blood vessel sutures (20%), previous fibula free flap failure (15%), and patient refusing free tissue transfer (8%). Aside from these medical indications, OMDS flaps were performed in 30% of cases due to organizational concerns. The mean flap length was 73±16 mm, with a maximum of 109 mm. Flap bone volume was stable over time, with negligible resorption (p = 0.761). Secondary pedicled flaps were used to treat OCF in 5 patients (12%). Secondary esthetic procedures were performed in 9 patients (22%). None of the 40 flaps were removed. None of the patients had long-term scarring complications in donor sites.OMDS flaps merit consideration for mandibular reconstruction when free tissue transfer is contraindicated or impossible due to organizational issues.     

The dissection of the rectus abdominis myocutaneous flap with complete preservation of the anterior rectus sheath.

Harvesting the rectus abdominis myocutaneous flap results in defects in both the rectus abdominis muscle and the anterior rectus sheath, which may be circumvented by dissecting a perforator flap (DIEP flap) instead. However, the latter is associated with a reduction in the number of myocutaneous perforators nourishing the flap, which has been hypothesised to lead to an increased risk of partial flap failure. We present a technical modification that maintains all the feeding perforators within the flap while fully preserving the anterior rectus sheath. The anterior rectus sheath is incised along a line connecting the perforators. A muscle cuff including all the feeding perforators was raised with the flap. This technique was used in 20 consecutive patients. Nine patients underwent free TRAM flap transfers for breast reconstruction (10 flaps), and 11 patients underwent thoracic-wall reconstruction with a superiorly based pedicled flap. The median follow-up was 11 months. One patient with a pedicled flap developed a partial failure that required surgical revision; all other flaps healed spontaneously. One patient in each subset had preoperative abdominal-wall laxity that was partly corrected after surgery; no abdominal bulging or hernia occurred in the other patients. Our results suggest that the technical modification presented here may enable the surgeon to dissect a rectus abdominis myocutaneous flap with maximal perforator-related flap perfusion and minimal donor-site morbidity. An advantage over the DIEP flap is that this technique is applicable to both free and pedicled flaps.     

Free flap reconstruction of oral composite defect complicated by intraoperative cardiac arrest: A case report

We report the case of intraoperative cardiac arrest of a patient undergoing free tissue harvest for an oral composite defect and subsequent completion of reconstruction with simultaneous double flaps. A 54‐year‐old man with advanced carcinoma of the tongue underwent near‐total glossectomy, segmental mandiblectomy, and bilateral neck dissections. We planned a fasciocutaneous anterolateral thigh flap to reconstruct the glossectomy defect, and a fibula osteocutaneous flap for the mandible defect. After the fibula flap harvest, the patient suffered a cardiac arrest. After a 4‐min code, the patient regained a sinus rhythm and became hemodynamically stable. We completed the cancer resection and banked the pedicled, osteotomized fibula flap in the lower extremity. We took the patient back to the operating room on postoperative day number 5 for successful reconstruction with simultaneous fibula and ALF flaps. The microvascular surgeon must always be poised to rapidly address intraoperative complications that may critically compromise the success of the free flap or, more seriously, jeopardize the patient's life. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.     

改良前臂皮瓣在舌和口底联合缺损修复中的应用

目的：介绍改良游离前臂皮瓣在舌、口底缺损修复中的应用效果。方法：应用改良前臂皮瓣同期游离移植修复因舌癌行扩大根治切除术后的舌、底联合缺损13例,术中根据舌、口底和牙槽骨缺损的大小设计、制备、利用改良前臂皮瓣;术中常规掀起前臂皮瓣皮岛,并保留血管蒂周围蜂窝结缔组织,形成包绕桡动静脉、头静脉的蜂窝结缔组织袖,游离移植于口内,吻合血管,再造舌并修复口底缺损。结果：前臂皮瓣全部成活,患侧颌面形态和舌外形恢复满意,舌动度较好,语音较清晰。结论：改良前臂皮瓣具有血管恒定,切取制备容易,组织量较丰富,具有较广的适应证,是同期修复舌癌术后舌和口底联合缺损的比较满意的方法,值得推广应用。     

Quality of life after free-flap reconstruction in patients with oral and pharyngeal cancer

BACKGROUND: Our aim was to investigate quality of life and outcome after microvascular free-flap reconstruction after oncologic surgery. METHODS: Forty-four patients with a large carcinoma in the oral cavity, oral pharynx, or hypopharynx underwent free-flap surgery with or without radiotherapy. Patients completed the University of Washington Quality-of-Life Questionnaire preoperatively and four times during the 12 postoperative months. Survival rates and complications were analyzed. RESULTS: Postoperative composite quality-of-life scores were significantly lower than before treatment with no significant overall improvement during the follow-up. The scores for disfigurement, chewing, speech, and shoulder function remained significantly below the preoperative level throughout the follow-up. Sociodemographic factors predicted quality of life. Heavy drinking and unemployment caused a 2.4-fold and a 4.4-fold increase in risk of death, respectively. The rates for overall survival, tumor recurrence, flap success, and surgical complications were consistent with previous literature. CONCLUSION: Sociodemographic variables affect quality of life and patient survival in patients with oral cancer treated with microvascular free-flap reconstruction.     

小腿内侧皮瓣在修复口底癌术后缺损中的应用

目的 研究小腿内侧皮瓣在口底癌术后缺损修复中的应用.方法 应用该修复方法,共进行了5例口底癌术后缺损的修复,并对该皮瓣的应用解剖,制作技术及其优缺点进行了讨论.结果 7侧小腿内侧皮瓣均获得成功.口内外伤口均愈合良好,取得了良好的修复效果.覆盖于小腿内侧皮肤缺损区的皮片全部成活.结论 小腿内侧皮瓣适用于口底癌术后组织缺损的修复.对于口腔颌面部肿瘤术后的软组织缺损可利用携带部分比目鱼肌的小腿内侧皮瓣修复软组织缺损.小腿内侧游离皮瓣的皮下脂肪薄,皮瓣较柔软且远离术区,术后供区隐蔽,损伤小.