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。

RECONSTRUCTION OF SOFT TISSUE DEFECTS IN ORAL AND MAXILLOFACIAL REGIONS AFTER TUMORS SURGERY USING CERVICAL PEDICLE TISSUE FLAPS

OBJECTIVE: To report 4 methods of reconstructing soft tissue defects in oral and maxillofacial regions after tumors resection using cervical pedicle tissue flaps. METHODS: One hundred seventy-two soft tissue defects were repaired with cervical myocutaneous flaps after resection of oral and facial cancer (165 cases of squamous cell carcinoma and 7 cases of salivary carcinoma). The clinical stage of the tumors was stage I in 21 cases, stage II in 116 cases and stage III in 35 cases. Primary sites of the lesions were the tongue (59 cases), buccal mucosa (55 cases), lower gingiva (26 cases), floor of the mouth (25 cases), parotid gland (4 cases) and oropharynx (3 cases). Infrahyoid myocutaneous flaps were used in 60 cases, platysma flaps in 45 cases, sternocleidomastoid flaps in 59 cases and submental island flaps in 8 cases. The sizes of skin paddle ranged from 2.5 cm x 5.0 cm to 5.0 cm x 8.0 cm. RESULTS: Among 153 survival flaps, there were 55 infrahyoid myocutaneous flaps, 40 platysma flaps, 52 sternocleidomastoid flaps and 6 submental island flaps. There were 11 cases of total flap necrosis and 8 cases of partial flap necrosis. The success rates were 91.67% (55/60) for infrahyoid myocutaneous flap, 88.89% (40/45) for platysma flap, 88.14% (52/59) for sternocleidomastoid flap and 75% (6/8) for submental island flap. After a follow-up of 3 11 years (5.7 years on average) among 101 cases local reccurence in 18 cases, cervical reccurence in 4 cases, distance metastasis in 2 cases. The survical rate at 3 years were 83.17% (84/101). CONCLUSION: Cervical pedicle tissue flaps have clinical value in reconstruction of small and medium-sized soft tissue defects after resection of oral and maxillofacial tumors.