岛状额瓣加胸锁乳突肌皮瓣一期修复颊癌术后大面积洞穿性缺损一例

目的探讨颊部大面积洞穿性缺损的修复方法和胸锁乳突肌皮瓣、额瓣联合修复的优缺点。方法2003年7月行颊癌扩大切除,功能性颈淋巴清扫术患者1例,遗留组织缺损范围皮面9 cm×7 cm,黏膜面4.5 cm×3.0 cm。以甲状腺上血管、枕动脉和颈外静脉胸锁乳突肌肌支为血管蒂的胸锁乳突肌皮瓣修复颊黏膜面,以颞浅血管为血管蒂的岛状额瓣修复颊部皮面,皮瓣大小分别为5 cm×3 cm和10 cm×6 cm。结果患者术后皮瓣、皮片均全部成活,创面Ⅰ期愈合。2周痊愈出院,颊部皮色、质地好。随访1年,肿瘤无复发,生活自理,语言、饮食正常。结论胸锁乳突肌皮瓣和额部岛状瓣可作为颊癌术后颊部大面积洞穿性缺损的一期修复的方法,操作简便、易行,且经济。

ONE-STAGE RECONSTRUCTION OF LAGRE THROUGH-AND-THROUGH DEFFECT OF CHEEK WITH A COMBINATION OF FOREHEAD SKIN FLAP AND STERNOCLEIDOMASTOID ISLAND MYOCUTANEOUS FLAP AFTER CANCER DISSECTION

OBJECTIVE: To study the methods and results of a combination of forehead skin flap and sternocleidomastoid island myocutaneous flap in the reconstruction of large through-and-through defect of check. Methods One case of check cancer received ampliative resection and functional neck dissection. The defect area of the skin side was 9 cm x 7 cm, of the mucosa side 4.5 cm x 3.0 cm. The defect of the mucosa side was repaired with sternocleidomastoid island myocutaneous flap which blood supply was from thyroidea superior artery, occipitalis artery and carotis extera vein; of the skin side with forehead skin flap which blood supply was from temporalis superficialis artery and vein. The size of the sternocleidomastoid island myocutaneous flap was 5 cm x 3 cm, of the forehead skin flap 10 cm x 6 cm. RESULTS: Two flaps and the split survived after operation. One-stage healing was achieved. The patient was discharged from hospital 2 weeks after operation. The color and the quality were good. The tumor did not recur during follow-up of one year. The patient could take care of herself, and she lived normally in talk and diet. CONCLUSION: A combination of forehead skin flap and sternocleidomastoid island myocutaneous flap is a useful method to repair large through-and-through defect of cheek after cancer dissection. It is easy-to-operate and economical.