游离皮瓣移植修复口腔颌面部缺损的临床效果观察

目的探讨游离皮瓣在修复口腔颌面部缺损中的临床应用价值。方法选择2006年03月—2010年08月中国医科大学口腔医学院口腔颌面外科用游离皮瓣修复口腔颌面部缺损病例168例,前臂游离皮瓣90例,股前外侧游离皮瓣39例,腓骨肌皮瓣31例,背阔肌皮瓣8例。术后观察皮瓣成活率和并发症。结果成功164(97.6%)例,失败4例,患者出现术后早期局部并发症6.5%(11/168),术后皮瓣危象发生率为5.4%(9/168),其中静脉血栓形成66.7%(6/9),手术探查抢救成功率55.6%(5/9),前臂桡侧皮瓣成活率97.8%(88/90);股前外侧皮瓣成活率97.4%(38/39);腓骨肌皮瓣成活率96.8%(30/31);背阔肌皮瓣8例全部成活,随访2～2.5年大部分患者外形及功能满意。结论游离皮瓣修复口腔颌面部缺损的成活率高,前臂皮瓣、股前外侧皮瓣、腓骨肌(皮)瓣、背阔肌皮瓣是修复口腔颌面部缺损的常用皮瓣。

Effects of microsurgical free flap transfer on oral and maxillofacial reconstruction

Objective To analyze the clinical value of microsurgical free flap transfers for oral and maxillofacial region reconstruction.MethodsOne hundred and sixty-eight consecutive microsurgical free flap transfers performed on patients who had oral and maxillofacial defects from premodinantly surgical procedure due to carcinoma from March 2006 to August 2010 were reviewed.Concerning data include 90 free radial forearm flap,31 free fibular flap,39 anterolateral thigh flap and 8 latissmus dorsi musculocutaneous flap.Observe the microsurgical free plap survival rate and complication postoperatively.ResultsThe overall success rate of flap was 97.6%（164/168）.The overall complication rate was 6.5%（11/ 168）.The flap crisis rate was 5.4%（9/168）including the vessel thrombosis rate 66.7%（6/9）,and the flap salvage rate was 55.6%（5/9）.Survival rate of radial forearm free flap,anterolateral thigh flap,fibular flap and latissmus dorsi musculocutaneous flap were 97.8%,97.4%,96.8%,100% respectively.The features and functions of patients were mainly satisfactory after 2~2.5 years′ follow-ups.ConclusionsMicrosurgical free flap transfer for oral and maxillofacial region defects is safe and reliable.The free radial forearm flap was most commonly used,followed by anterolateral thigh flap,fibular free flap and latissimus dorsi flap.