游离延展上臂外侧皮瓣在口腔癌术后软组织缺损中的应用

目的 探讨游离延展上臂外侧皮瓣修复口腔癌术后软组织缺损的临床疗效。方法 2011年1月—2013年12月，应用游离延展上臂外侧皮瓣一期修复15例口腔癌扩大切除术造成的软组织缺损，术前应用多普勒血流探测仪测量桡侧副动脉无变异后，根据其走行以及术中软组织缺损的面积、形态设计皮瓣，皮瓣均越过肱骨外上髁，面积为4 cｍ×5 cm～11 cm×5 cm，血管蒂长约10cm。供区创面直接拉拢缝合。结果 14例皮瓣成活，１例因术后第2天发生动脉血管危象，抢救皮瓣无效，皮瓣坏死。术后随访12个月以上，所有患者均无肿瘤复发，肘部瘢痕较细，肘运动无障碍，未出现桡神经损伤引起的垂腕，２例患者供区局部有麻木感，６个月后症状减轻。术后患者语言功能恢复良好，鼻咽纤维镜检查吞咽顺利，腭咽闭合良好。所有患者ｌｉｋｅｒｔ评分法均为4～5分。结论 游离延展上臂外侧皮瓣解剖恒定、厚度适宜、血供可靠，是修复口腔癌术后软组织缺损的一种较好的选择。

Use of extend lateral upper arm free flap for reconstruction of soft tissue defect after resection of oral cancer

PURPOSE To investigate the clinical outcomes of composite lateral arm free flap to reconstruct soft tissue defect after oral cancer ablation. METHODS Fifteen cases of soft-tissue defects were reconstructed using composite lateral arm free flap from January 2011 to December 2013. Color Doppler ultrasound blood flow detector was used to avoid variation of posterior radial collateral artery (PRCA). Composite flaps were designed according to the direction of PRCA, shape and area of the soft-tissue defect, which were over condylus lateralis humeri, with areas ranged from 4 cｍ×5 cm-11 cm×5 cm and an average vascular pedicle length of 10cm. Primary closure was achieved on all donor sites. RESULTS Fourteen flaps survived while vascular crisis was found in one flap 1 day post operation. The flap was replaced after an invalid salvation. All patients were followed up over 12 months, no recurrence was found. All patients achieved good recovery of morphology and functions with only 2 reporting local numbness of donor sites, which were relieved after 6 months.CONCLUSIONS Composite lateral arm free flap, with consistent anatomy, suitable thickness and reliable blood supply, is a proper method to reconstruct postoperative soft tissue defect of patients with oral carcinoma.