游离组织辦在口腔颌面-头颈肿瘤缺损修复中的应用:2549例临床分析

目的:探讨不同游离组织瓣在口腔颌面-头颈肿瘤缺损与修复中的应用价值。方法:回顾分析1979年1月～2006年12月间,我院口腔颌面外科所行血管化游离组织瓣移植患者2549例,共制备皮瓣2684块:软组织瓣包括前臂皮瓣、背阔肌皮瓣、胸大肌皮瓣、股前外侧皮瓣、肩胛皮瓣等;骨组织瓣包括腓骨肌皮瓣、髂骨肌皮瓣、肩胛骨肌皮瓣等。分别用于修复舌、腭、颊、口底、颌骨及面颈部大面积复合缺损。统计各年代游离组织瓣移植的成功率,分析失败原因。结果:游离组织瓣移植成功率从80年代初期(92%)至今(98.5%),呈逐年升高趋势,2684块皮瓣总成功率达96.80%。前臂皮瓣是最常用的游离组织瓣(64.12%),胸大肌皮瓣和背阔肌皮瓣在修复大面积复合缺损常被采用,各种骨肌(皮)瓣应用于颌骨缺损修复成为近年的热点。大范围复合组织缺损的救治性手术常需要多个游离组织瓣联合修复重建。结论:血管化游离组织瓣移植是口腔颌面-头颈肿瘤手术根治的保障,更是术后缺损修复的主要手段。前臂皮瓣是修复舌、颊、腭等软组织缺损的首选瓣,胸大肌与背阔肌(皮)瓣适合修复体积较大的缺损,腓骨、髂骨肌瓣是上、下颌骨缺损最常用的修复手段。其他不常用的组织瓣,应根据不同适应证进行选择。采用不同组织瓣修复口腔颌面部缺损,对患者术后外形及功能具有重要意义。

Free flap for reconstruction of oral maxiliofacial and head neck defects:Clinical analysis of 2549 cases

PURPOSE: To assess the results of different free flaps in reconstruction of oral and maxillofacial defects. METHODS: 2549 patients with 2684 flaps treated during 1979-2006 with vascularized free flaps were involved in this retrospective study. Soft free flaps included forearm flap,latissimus dorsi myocutaneous flap,pectoralis major myocutaneous flap (PMMF),anterial lateral thigh flap and scapular flap et al. Bone flaps included fibular flap,vascularized iliac flap and scapula flap. These flaps were used to reconstruct the defects of the tongue,palate,cheek,floor of mouth,maxilla and mandible. The successful rate was assessed during different periods. RESULTS: The successful rate was from 92% in 1980's to 98.5% nowadays,96.80% in average. The forearm flap was the most common flap in reconstruction of the defects(64.12%),latissimus dorsi myocutaneous and PMMF were always used in reconstruction of combined defects. Bone flaps were used in maxilla and mandibular reconstruction. More than one free flaps were necessarily combined to reconstruct complicated defects. CONCLUSION: Reconstruction with free flap afforded the great possibility for tumor resection. Forearm flap was the best choice for tongue,cheek,floor of mouth reconstruction. Latissimus dorsi myocutaneous and PMMF were the favorite choice for huge bulk defects. Vascularized iliac flap and fibular flap were commonly used for jaw reconstruction. The free flap transplantation was the mainstay of oral and maxillofacial reconstruction. Selection and application of proper flap is important to esthetic and functional rehabilitation.