【作者】 吴湘卿； 吴汉江； 朱兆夫； 刘金兵； 王志平； 段红明； 王铠； 谭宏宇； 张胜； 龚朝建； 李运良；

【Author】 WU Xiang-qing,WU Han-jiang,ZHU Zhao-fu,LIU Jin-bing,WANG Zhi-ping,DUAN Hong-ming, WANG Kai,TAN Hong-yu,ZHANG Sheng,GONG Zhao-jian,LI Yun-liang. (Department of Stomatology,Xiangya Second Hospital,Central South University,Changsha 410011,China)

【机构】 中南大学湘雅二医院口腔中心颌面外科；

【摘要】 目的:探讨游离股前外侧皮瓣修复腭部、咽侧恶性肿瘤术后缺损的适应证、方法及临床效果。方法:回顾性分析2007年1月至2009年6月我科采用游离股前外侧皮瓣修复腭部、咽侧恶性肿瘤术后缺损14例。男12例,女2例,平均年龄57.64岁(30～73岁)。14例患者均Ⅰ期行股前外侧皮瓣修复,皮瓣最小面积为4×6cm2,最大面积为7×17cm2。其中部分软腭缺损6例,采用咽侧后壁粘膜瓣修复鼻腔侧粘膜,皮瓣修复口腔侧粘膜。部分软腭+咽侧壁缺损5例,全软腭+咽侧缺损3例,采用皮瓣的阔筋膜修复鼻腔侧、咽侧粘膜,皮瓣修复口腔侧粘膜。结果:14例皮瓣全部成活,成功率为100%,无伤口感染及口鼻瘘发生。供区创面均直接拉拢缝合,伤口Ⅰ期愈合。术后腭部、咽侧皮瓣较臃肿,3个月后皮瓣逐渐萎缩,半年后腭部、咽侧的形态逐渐接近正常解剖外形。患者术后的语言、吞咽功能恢复满意。结论:股前外侧皮瓣有一定的厚度,其修复腭部、咽侧缺损时,鼻腔侧粘膜或阔筋膜与皮瓣紧密贴合,不易出现伤口积液,同时舌肌的压力有利于皮瓣的塑形;术后初期腭部、咽侧较臃肿,半年后逐渐接近正常解剖外形且功能恢复满意,其效果优于前臂皮瓣,是腭部、咽侧缺损修复重建的理想皮瓣;对于部分软腭缺损的重建,可以用咽侧后壁粘膜瓣修复鼻腔侧粘膜,皮瓣修复口腔侧粘膜;部分软腭+咽侧壁及全软腭+咽侧壁缺损的重建,可以用阔筋膜修复鼻腔侧、咽侧壁粘膜,皮瓣修复口腔侧粘膜。更多还原

【Abstract】 Objective:To discuss the indication,methods and clinical effect of the reconstruction of palate and lateropharyngeal defects with free anterolateral thigh flap.Methods:The retrospective analysis that we reconstructed the palate and lateropharyngeal defects inⅠphase with free anterolateral thigh flap in 14 cases was carried out,all the defects were repaired following the malignant tumors resection from Jan.2007 to Jun.2009.12 cases were men and 2 cases were women.The average age was 57.64(30～73) years.The size of the flaps ranged from 4×6cm2 to 7×17cm2.For 6 cases which were partial soft palate defects,we repaired the nasal side mucosa with lateral and posterior pharyngeal flaps and repaired the oral side mucosa with anterolateral thigh flaps.For 5 cases which were partial soft palate defects + lateropharyngeal defects and 3 cases which were entire soft palate defects + lateropharyngeal defects,we repaired the nasal side and lateropharyngeal mucosa with fascia lata and repaired the oral side mucosa with flaps.Results:The survival rate of the flaps was 100%.There was no oronasal fistula and infection occurred among the patients.All the wounds of the donor site were closed directly and healed inⅠstage.The flaps were fat.After 3 months,the flaps began to have some shrinkage.Six months later,the shape of palate and pharynx seemed to be nearly normal anatomical shape.The linguistic and swallowing function was satisfactory. Conclusions:When anterolateral thigh flap is used to repair palate and lateropharyngeal defects,there is no dead space between the flap and nasal side mucosa or fascia lata.Therefore,wound effusion is very rare.The pressure of tongue is conducive to the flap shaping. The palate and pharynx are fat in the early after the surgery,but six months later,the shape seemed to be nearly normal anatomical shape and the function is satisfactory.Anterolateral thigh flap is a perfect flap to reconstruct the palate and lateropharyngeal defects,and the effect is better than forearm flap.For partial soft palate defects,the lateral and posterior pharyngeal flaps could be used to repair the nasal side mucosa and the flaps for oral side mucosa.For partial soft palate + lateropharyngeal defects and entire soft palate + lateropharyngeal defects,the fascia lata could be used to repair the nasal side and lateropharyngeal mucosa,the flaps for oral side mucosa.更多还原