游离皮瓣修复头颈部肿瘤术后组织缺损△

目的 探讨不同游离皮瓣在头颈部肿瘤术后组织缺损修复应用中的优缺点。方法 回顾分析46例经游离皮瓣修复的头颈部恶性肿瘤病例临床资料,其中扁桃体癌11例、下咽癌17例、舌根会厌癌4例、鼻腔鼻窦癌术后放疗后复发14例。根据肿瘤切除术后缺损部位和大小,分别采用前臂桡侧皮瓣、股前外侧瓣和背阔肌皮瓣修复术后组织缺损。结果 46例恶性肿瘤患者,应用前臂皮瓣修复20例,应用股前外侧瓣修复20例,采用背阔肌修复6例。46例游离皮瓣成活42例(91.3%)。修复扁桃体癌术后缺损的11例患者,综合治疗后3年总生存率为72.7%(8/11);修复下咽缺损的17例患者,综合治疗后3年总生存率为64.7%(11/17);全舌加全喉切除术后缺损修复的4例患者,综合治疗后3年总生存率为50%(2/4);14例复发性鼻腔鼻窦癌患者,再次手术后总生存率为21.4%(随访2~5年)。结论 游离前臂皮瓣和股前外侧瓣能满足头颈部肿瘤术后不同大小缺损修复的需求。

Reconstruction of tissue defects with free skin flaps after surgery in head and neck cancer patients

Objective To explore the advantages and disadvantages of different kinds of free skin flaps for the reconstruction of the tissue defects after surgery in head and neck cancer patients. Methods Data of 46 patients with head and neck malignant tumor whose tissue defects had been repaired with free skin flaps were analyzed retrospectively. There were 11, 17 and 4 patients with tonsil, hypopharyngeal and tongue root-epiglottic cancers respectively. Besides, there were 14 cases of recurrent tumors of nasal cavity and paranasal sinuses after surgery and radiotherapy. According to the location and size of the defects, they were individually reconstructed with free radial forearm, anterolateral thigh and latissimus dorsal muscular flaps respectively. Results There were a total of 20 and 6 patients’ tissue defects were repaired with free radial forearm and latissimus dorsal muscular flaps respectively. The remaining was reconstructed with free anterolateral thigh flaps. In the 46 cases of flaps, 42 (91.3%) survived well finally. The 3-year overall survival rates were 72.7%, 64.7% and 50% respectively in tonsil cancers, hypopharyngeal and tongue root-epiglottic cancers respectively, while the survival rate was only 21.4% in patients with the recurrent nasal cavity and the paranasal sinuses cancers after surgery and therapy. Conclusions The free radial forearm and anterolateral thigh flaps were used to reconstruct the tissue defects after operation in head and neck cancers.