游离胫后动脉穿支皮瓣在局部晚期下咽癌喉功能保留中的应用

目的探讨游离胫后动脉穿支皮瓣在修复局部晚期下咽癌喉功能保留术后缺损的临床价值。方法回顾性分析华西医院耳鼻咽喉头颈外科在2009年8月~2019年1月在下咽癌喉功能保留手术中采用游离胫后动脉穿支皮瓣修复的20例患者临床资料。患者均为男性，年龄47～67岁，病理类型均为鳞状细胞癌。其中梨状窝癌14例，下咽后壁癌6例。皮瓣的面积为4 cm×7 cm~7 cm×12 cm。小腿供瓣区采用腹部全厚皮移植。术后患者均行后续放/化疗。结果术后所有皮瓣均全部存活，无皮瓣坏死及血管危象发生。6例患者术后出现低蛋白血症，4例出现肺部感染，4例出现咽瘘，1例出现供区植皮坏死。所有患者均拔除鼻饲管后经口进食，1例继发喉狭窄。肿瘤控制情况：2例局部复发，其中1例行挽救性全喉切除术，1例死亡。2例出现颈部淋巴结转移，均再次接受根治性颈淋巴结清扫术。结论游离胫后动脉穿支皮瓣具有穿支血管解剖恒定，厚薄适中，血管蒂长和供区隐蔽等优点，术后能耐受根治性放疗，是下咽癌术后缺损重建的理想选择之一。

Application of free posterior tibial artery perforator flap in the preservation of laryngeal function in locally advanced hypopharyngeal carcinoma

ObjectiveTo discuss the clinical value of free posterior tibial artery perforator flap in the reconstruction of defects after preserving laryngeal function surgery in locally advanced hypopharyngeal carcinoma.MethodsClinical data of 20 patients with free posterior tibial artery perforator flap to preserve laryngeal function in hypopharyngeal carcinoma surgery hospitalized in our department from Aug 2009 to Jan 2019 were analyzed retrospectively. All the patients were male, aged from 47 to 67 years old. The pathological types of the tumor were all squamous cell carcinoma. The primary sites of the tumor were located in piriform sinus in 14 cases and hypopharyngeal wall in 6. The area sizes of the flaps were (4 cm×7 cm) to (7 cm×12 cm). Abdominal full thickness skin graft was transplanted to the calf donor site. All patients underwent postoperative chemoradiotherapy.ResultsAll flaps survived with neither flap necrosis nor vascular crisis. Postoperative hypoproteinemia, pulmonary infection, pharyngeal fistula and donor skin necrosis occurred in 6, 4, 4 and 1, respectively. All patients underwent oral feeding after removal of the nasogastric tube, and one got secondary laryngeal stenosis. As for the oncologic outcomes, one of the 2 patients with local recurrence underwent salvage total laryngectomy and another one died, 2 cases with cervical lymph node metastasis underwent radical neck dissection.ConclusionWith advantages of constant anatomy of the perforating vessels, moderate thickness, long vascular pedicle and concealed donor site as well as good tolerance to postoperative radical radiotherapy, free posterior tibial artery perforator flap is one of the ideal choices for reconstruction of defects after hypopharyngeal carcinoma surgery.