游离组织瓣修复口腔颌面部缺损183例临床分析

目的:总结游离组织瓣在口腔颌面部软、硬组织缺损修复中的应用及提高其成功率的经验。方法 :2001—2011年(10年)期间,我院行游离组织瓣修复口腔颌面部缺损的病例共计183例,其中前臂皮瓣91例,腓骨复合组织瓣78例,股前外侧皮瓣14例,用于修复舌、颊、腭、口底、上颌骨、下颌骨等部位缺损,回顾性分析其成活率及术后并发症。结果:179块组织瓣成活,总成活率为97.8%,失败率为2.2%。其中前臂皮瓣成活率为96.7%,腓骨复合组织瓣为98.7%,股前外侧皮瓣为100%。结论 :前臂皮瓣是口腔颌面部软组织缺损修复的首选皮瓣,股前外侧皮瓣只有在大范围缺损时使用,对于上、下颌骨缺损均可采用腓骨复合组织瓣修复。术后1周内监测皮瓣,及时发现血管危象并手术探查处理,是保证游离组织瓣成活的关键。

Free Tissue Flap Reconstruction in Oral and Maxillofacial Defects

Objective: To summarize the clinical experience applying free tissue flap to repair the oral and maxillofacial defects.Methods: From 2001 to 2011,183 patients treated with vascularized free flap were involved in this retrospective study,which were included 91 free radial forearm flap,78 free fibular flap,14 anterior-lateral thigh flap.These flaps were used to reconstruct the defects of the tongue,palate,cheek,floor of month,maxilla and mandible.The free flap survival rate and postoperative complications were evaluated.Results: The success rate of free flap was 97.8%.The flap crisis rate was 2.2%.Survival rate of radial forearm flap was 96.7%,fibular flap was 98.7%,and anterior-lateral thigh flap was 100%.The forearm flap was the most common selected soft tissue flap in reconstruction of the defect.Anterior-lateral thigh flap was often used in reconstruction of combined defects.Maxilla and mandibula reconstruction only used fibular flap. Conclusions: Reconstruction with free tissue flap afforded the great possibility for oral maxillofacial tumor resection.