多种组织瓣在口颊缺损重建中的应用

背景与目的：合理采用组织瓣进行口颊缺损重建，可以扩大口颊癌手术指征，改善患者的生存质量，延长患者生命。本研究目的是探讨组织瓣重建口颊缺损的指征，不同组织瓣的选择以及重建的手术技巧。方法：2005年9月至2007年8月间共行26例组织瓣重建口颊缺损手术，其中单纯口颊粘膜切除8例；口颊大型缺损18例，其中包括口颊面部皮肤洞穿切除11例，口颊、皮肤以及口角全缺损切除7例。26例患者中有7例行腮腺导管切除。胸大肌肌皮瓣转移重建5例，游离前臂桡侧皮瓣重建11例，游离股前外侧皮瓣6例，胸锁乳突肌肌皮瓣4例。8例患者行术后放疗，剂量为66～70Gy。结果：围术期无死亡病例，1例皮瓣坏死，为游离前臂皮瓣重建病例；1例皮瓣部分坏死，为胸大肌肌皮瓣重建病例。皮瓣成功率为96．2％（25／26）。1例伤口积液，为涎腺瘘。所有患者均随访1-3年，7例复发患者中4例为原发灶复发，3例为颈部淋巴结复发。随访期间2例患者死亡，均为原发灶局部复发者。结论：游离股前外侧皮瓣和游离前臂皮瓣是重建口颊大型缺损的良好皮瓣，是大于4cm的口颊缺损的首选：胸大肌肌皮瓣可作为口颊大型缺损重建的备用皮瓣；小于4cm的口颊缺损可选用胸锁乳突肌肌皮瓣。

Application of various flaps to intraoral reconstruction of buccal defects after resection of buccal mucosa carcinoma

Background and Objective： proper flaps can expand the indications and prolong survival. This study was to Reconstructing buccal defects with of surgery, improve quality of life investigate the indications for such application, the selection of different kinds of flaps and the skills of the reconstructive operation. Methods： From September 2005 to August 2007, 26 patients underwent reconstructive operation after resection of buccal mucosa carcinoma, eight had simple buccal mucosa resection, 11 had resection of the bucca cavioris and facial skin, seven had resection of the bucca cavioris, facial skin and angulus oris; besides, seven patients underwent parotid duct resection. As for the reconstructive operation, pectoralis major myocutaneous flap was used in five patients, free radial forearm flap in 11 patients, free anterolateral thigh flap in six patients, and sternodeiceomastoid myocutaneous flap in four patients. Eight patients received postoperative radiotherapy at 66- 70 Gy. Results：No perioperative death occurred. Necrosis happened in one patient who used free radial forearm flap; partial necrosis in one patient who used pectoralis major myocutaneous flap. The survival rate of the flaps was 96.2%. Hydrops of the operative wound happened in one patient with salivary fistula. During the follow-up of 1-3 years, seven patients had recurrence （four had recurrence in primary lesion and three in cervical lymph nodes）, two died of recurrence in primary lesion. Conclusion： The free anterolateral thigh flap and free radial forearm flap are suitable for reconstruction of large buccal defects, and are first-choices for defects larger than 4 cm; the pectoralis major myocutaneous flap can be applied as the second-choice flap; the sternodeiceomastoid myocutaneous flap can be used for defects smaller than 4 cm.