【作者】 彭歆； 毛驰； 俞光岩； 郭传； 张雷； 王洋； 黄敏娴； 马大权；

【Author】 PENG Xin,MAO Chi,YU Guang-yan,GUO Chuan-bin,ZHANG Lei, WANG Yang,HUANG Min-xian,MA Da-quan (Department of Oral and Maxillofacial Surgery,Peking University School of Stomatology)

【机构】 北京大学口腔医学院口腔颌面外科；

【摘要】 目的:比较分析前臂皮瓣、大腿前外侧皮瓣和上臂外侧皮瓣修复口腔颌面部肿瘤术后缺损的临床应用。材料和方法:收集同期完成的154例应用软组织皮瓣修复口腔颌面部肿瘤术后缺损修复患者的临床资料,其中前臂皮瓣99例,大腿前外侧皮瓣34例,上臂外侧皮瓣21例,对比分析三种皮瓣患者的组织缺损情况、平均手术制备时间、皮瓣移植成功率及术后并发症情况。结果:前臂皮瓣、大腿前外侧皮瓣和上臂外侧皮瓣三种皮瓣修复的缺损部位均包括上颌、腭、舌、颊、磨牙后区和口咽,大腿前侧皮瓣更多应用于上颌骨缺损的修复(16/34)。三种软组织皮瓣的平均手术制备时间分别是41.5分钟、46.4分钟和42.4分钟,移植成功率分别是96.0%、94.1%和90.5%,均无统计学差异。所有前臂皮瓣患者均需供区植皮,所有大腿前外侧皮瓣和上臂外侧皮瓣患者供区均可直接缝合,无需植皮。1例前臂皮瓣患者和2例上臂外侧皮瓣患者出现术后桡神经损伤症状。结论:大腿前外侧皮瓣和上臂外侧皮瓣供区隐蔽,无需植皮,移植成功率高,可作为前臂皮瓣的替代和补充,丰富口腔颌面部肿瘤术后缺损的修复手段,提高治疗效果。更多还原

【Abstract】 Objective:To compare the application of the forearm flap,anterolateral thigh flap and lateral arm flap when reconstructing the oral-maxillofacial defects.Methods:154 consecutive cases of various defects reconstruction with the three kinds of soft tissue free flaps were reviewed.There were 99 cases with forearm flap,34 cases with anterolateral thigh flap and 21 cases with later arm flap.All the clinic data including the primary diseases,the site of defects,the average operation time of flap harvest,the survival rate of flap transfer and the perioperative complications were analyzed.Results:All the forearm flap,anterolateral thigh flap and lateral arm flap could reconstruct the defects of maxilla,palate,tongue,cheek,retromolar and oralpharyngeal,anterolateral thigh flap were more often used for maxillary reconstruction(16/34).The average operation time of the flap harvest was 41.5min,46.4min and 42.4min respectively, and the survival rate was 96.0%,94.1%and 90.5%respectively.There was no significant difference among the three groups.Skin graft is necessary for the donor site in all the cases with forearm flap.The donor site could be closed directly without skin graft in all the cases with anterolateral thigh flap and lateral arm flap.Radial nerve injury was reported in one case with forearm flap and 2 cases with lateral arm flap.Conclusions:The anterolateral thigh flap and lateral arm flap are safe and reliable alterative to the forearm flap for oral-maxillofacial defects reconstruction with the advantages of non-visible donor site scar and no need of skin graft.更多还原