前臂皮瓣联合邻近组织瓣修复腭及上颌组织缺损早期疗效

目的探讨游离前臂皮瓣联合邻近组织瓣修复腭、上颌组织缺损的方法和疗效。方法 2005年3月-2010年5月收治17例腭及上颌部肿瘤患者。男11例,女6例;年龄45～74岁,平均62.5岁。良性肿瘤1例;恶性肿瘤16例,其中腭部鳞状细胞癌7例,腭部鳞状细胞癌术后复发1例,腭部恶性黑色素瘤1例,腭部腺样囊腺癌1例,上颌恶性黑色素瘤1例,上颌导管癌1例,上颌鳞状细胞癌4例。病灶切除后缺损范围为7.0cm×5.5cm～10.0cm×7.5cm;根据Brown等对上颌骨缺损的分类标准,Ⅱ类15例,Ⅲ类2例;合并眶底、眶下缘骨质缺损2例。根据腭、上颌组织缺损类型,以游离前臂皮瓣联合颊脂垫行即刻修复11例,以游离前臂皮瓣联合颊脂垫及颞肌下颌骨骨肌瓣即刻修复6例。术后观察组织瓣成活情况及语言、吞咽、呼吸功能恢复情况及患者面部外形恢复情况。结果 17例前臂皮瓣和邻近组织瓣均成活;供区植皮均成活,切口均Ⅰ期愈合。患者均获随访,随访时间6～12个月。肿瘤无复发。患者语言、吞咽、呼吸基本正常,无明显开口受限,面部外形满意,无严重畸形。合并眶底、眶下缘骨质缺损者,未出现眼球内陷。患者术后均无明显口鼻瘘,口、鼻腔功能恢复满意。结论根据腭、上颌组织缺损的情况,选择游离前臂皮瓣联合颊脂垫或颊脂垫及下颌骨骨肌瓣进行修复,可达到较好的早期疗效。

Early effectiveness of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects

Objective To investigate the method of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects and its effectiveness.Methods Between March 2005 and May 2010,17 patients with palatomaxillary defects were treated.There were 11 males and 6 females with an age range of 45-74 years(mean,62.5 years),including 1 case of benign tumor and 16 cases of malignant tumors(7 cases of squamous cell carcinoma of palate,1 case of recurring squamous cell carcinoma of palate,1 c...