CT血管成像个体化设计股前外侧穿支皮瓣在头颈外科手术中的应用

目的 探讨应用CTA个体化设计股前外侧穿支皮瓣(ALTPF)在头颈外科手术中的应用及疗效。方法 回顾性分析2012年3月—2014年6月四川省肿瘤医院头颈外科收治的20例头颈部肿瘤患者的临床资料。其中男11例,女9例;年龄24～79岁,平均51.42岁;舌癌13例、 口底癌2 例、口颊癌 3例、下咽癌2例。患者均行原发灶扩大根治术及单侧或双侧颈淋巴结清扫术,病灶切除后创面软组织缺损范围6 cm×5 cm～10 cm×7 cm;根据术前CTA检查结果进行ALTPF的设计、定位,应用ALTPF移植修复头颈部肿瘤根治性切除术后的创面缺损;供区处理直接分层拉拢缝合。术中观察供区股前外侧穿支血管与术前影像学定位是否吻合;术后观察皮瓣成活、创面愈合情况,随访观察皮瓣质地、供区功能以及患者满意度。结果 20例患者均顺利完成手术,术中所见穿支与术前影像学定位分析均相符。其中切取单一游离ALTPF 12例,皮瓣大小6 cm×5 cm～10 cm×7 cm;一蒂双皮瓣3例、复合肌皮瓣5例,同蒂肌瓣大小2 cm×3 cm～3 cm×4 cm,血管蒂长7～10 cm,平均(8.0±2.23)cm。19例患者移植皮瓣完全存活;1例术后局部感染致皮瓣部分坏死,剪除坏死皮瓣、组织,予换药后残余皮瓣存活。20例中,供区创面一期愈合19例,因积液导致供区伤口愈合延迟1例。术后20例均获随访,随访时间6～30个月,平均13.6个月。随访期间移植皮瓣颜色及质地与周围组织相近,大腿供区无一例发生下肢功能障碍。18例患者无瘤生存,2例患者局部肿瘤复发,再次手术用胸大肌皮瓣修复。结论 术前CTA能精确提供ALTPF穿支血管的解剖学特征,指导不同类型ALTPF的术前设计,个体化修复头颈部肿瘤根治性切除术后的创面缺损。

The individualized design of anterolateral thigh perforator flap penetration with CT angiography in the application of head and neck surgery

Objective To investigate the application and efficacy of individual designed anterolateral thigh perforator flap (ALTPF) by CT angiography(CTA) in head and neck surgery.MethodsA retrospective analysis of Sichuan Provincial Cancer Hospital Head and Neck Surgery ALTPF transplant repair from March 2012 to June 2014 lines of head and neck tumor radical resection 20 patients of head and neck cancer patients, which among 11 males and 9 females. The age ranged from 24 to 79 years, mean age was 51.42 year. 13 patients of tongue, floor of mouth cancer 2 patients, buccal cancer 3 patients, 2 patients of hypopharyngeal. All patients underwent primary tumor extended radical mastectomy and unilateral or bilateral neck dissection. The defects ranged from 6 cm ×5 cm to 10 cm × 7 cm. To design and locate the ALTPF by the findings of preoperative CTA and reconstruct the wound defect by the radical resection. And the donor sites were layered sutured directly. Observation whether the donor site anterolateral thigh perforator vessels was consistent with preoperative imaging positioning during surgery. The indexes of flap survival and wound healing were observed, and flap texture, donor site function and patients′ satisfaction in follow-up were evaluated.Results Surgery was successfully performed in 20 patients, and the consistent rate of intraoperative findings through branches with preoperative imaging localization was 100%. There were 12 patients of single free ALTPF, 3 patients of double flaps with one vascular pedicle, and 5 patients of compound muscle flaps. The flap size ranged from 6 cm×5 cm to 10 cm×7 cm, and the additional muscle flaps′ size ranged from 2 cm×3 cm to 3 cm×4 cm. The length of vascular pedicle ranged 7 cm to 10 cm mean (8.0±2.23) cm]. Nineteen flaps were fully alive, the other one was partly alive. The reason of partial necrosis was local infection, and then the remaining part survived by dressing and trimming. In 20 patients donor site wounds, 19 patients were primary healing and 1 patient delayed healing for effusion in operation area. All patients were followed up from 6 to 30 months, average 13.6 months. Appearance and consistency of the flaps were satisfying. No case of thigh donor site occurred limb dysfunction. Eighteen cases of patients with tumor-free survival, local tumor recurrence in two patients, which reoperation repairing by pectoralis major flap.Conclusions Preoperative CTA can provide ALTPF precise anatomical information through vessel characteristics, different types of guidance anterolateral thigh perforator flap preoperative design individualized repair of head and neck defects.