下腹部浅动脉穿支皮瓣与前臂皮瓣供区远期功能恢复的比较

目的比较口腔癌病人同期应用下腹部浅动脉穿支皮瓣和前臂皮瓣供区术后远期并发症，评价下腹部浅动脉穿支皮瓣在临床应用中的价值。方法回顾性分析因病灶扩大切除而行游离下腹部浅动脉穿支皮瓣（腹壁浅动脉穿支皮瓣或旋髂浅动脉穿支皮瓣）修复的口腔癌病人15例（观察组）临床资料，以及同期行前臂皮瓣修复的口腔颌面软组织缺损病人15例（对照组），比较2组病人术后供区远期并发症发生情况，包括感觉异常、瘢痕增生以及色素沉着等，并评估供区远期功能恢复情况。结果观察组病人供区创面经潜行分离后，直接拉拢缝合，术后仅遗留线形瘢痕，对美观和功能影响较小；对照组病人供区创面均植皮修复，术后供区瘢痕增生和色素沉着较明显。病人皮瓣术后供区主观感受比较显示，2组肌力减退情况差异无统计学意义（P>0.05），观察组感觉异常、供区外观主观评价情况均明显优于对照组（P<0.01）。2组病人供区感觉与功能、外观的客观检查中，观察组肌力减退、感觉异常情况均优于对照组（P<0.05和P<0.01），瘢痕色泽、厚度、血管分布、柔韧度和总分亦均明显优于对照组（P<0.01）。结论应用下腹部浅动脉穿支皮瓣修复，供区并发症少，对供区美观、功能影响小，是口腔颌面部软组织缺损修复的较好选择。

Comparison of the long-term functional recovery of the donor site between the superficial inferior abdominal artery perforator flap and forearm flap

ObjectiveTo evaluate the clinical value of the superficial inferior abdominal artery perforator flap in oral cancer patients by comparing the long-term complications of the donor site between the superficial inferior abdominal artery perforator flap and forearm flap.MethodsThe clinical data of 15 oral cancer patients(observation group) treated with free superficial inferior abdominal artery perforator flaps(superficial inferior epigastric artery perforator flaps or superficial circumflex iliac artery perforator flaps) for extensive resection of lesions and 15 oral and maxillofacial soft tissue defect patients(control group) treated with forearm flaps to repair at the same time were retrospectively analyzed.The long-term complications of the donor site(including paresthesia, hyperplasia of scar and pigmentation) were compared between two groups, and the long-term functional recovery of the donor site was evaluated in two groups.ResultsIn the observation group, the donor wound was directly pulled and sutured after stealth separation, and only linear scar was left after surgery, which had little effect on aesthetics and function.In the control group, the skin grafting was performed on the donor wounds, and the postoperative hyperplasia and hyperpigmentation of scars were obvious.The comparison results of the subjective feelings of patients in the donor site after skin flap surgery showed that there was no statistical significance in the decrease of muscle strength between two groups(P>0.05), and the paresthesia and subjective evaluation of the donor site appearance in observation group was significantly better than those in control group(P < 0.01).In the objective examination of the sensation, function and appearance of the donor site of patients in two groups, the muscle strength decreasing and paresthesia in observation group were better than those in control group(P < 0.05 and P < 0.01), and the color, thickness, vascular distribution, flexibility and total score of scar in observation group were also significantly better than those in control group(P < 0.01).ConclusionsThe superficial inferior abdominal artery perforator flap is a good choice for the repair of oral and maxillofacial soft tissue defects, which has less complications at the donor site and less influence on the appearance and function of the donor site.