【摘要】 目的：比较不同皮瓣修复法对口腔癌术后颌面组织缺损伤口美观度的影响。方法：回顾性分析2019年6月-2023年6月于医院就诊的120例口腔癌术后颌面组织缺损患者的临床资料，按照治疗方法将接受游离前臂皮瓣修复法的患者纳入A组(n=58)，接受颏部岛状皮瓣修复法治疗的患者纳入B组(n=62)。比较两组围术期指标、术后皮瓣成活率、患者和观察者瘢痕评价量表(Patient and observer scar assessment scale，POSAS)评分；比较修复前、后两组口腔功能、生活质量；观察两组供、受区形态；比较两组患者并发症。结果：B组术中出血量少于A组(P<0.05)；两组皮瓣制备时间、术后皮瓣成活率比较，差异均无统计学意义(P>0.05)；B组观察者POSAS量表评分、患者POSAS量表评分均低于A组(P<0.05)；修复前、后两组口腔外形、吞咽能力、语言功能、咀嚼功能、口腔闭合评分及生活质量量表(SF-36)评分比较，差异均无统计学意义(P>0.05)；患者皮瓣供区均实现一期拉拢缝合，两组各有1例患者由于供区创口张力过大，导致创口周围皮肤坏死，经过清创、引流后创口愈合良好。其余患者供区功能运动均正常，活动度良好，无麻木，患者对供区功能保存及美观均满意。B组受区成活皮瓣均具有良好的外形，皮瓣软、薄，外形良好，无明显肿胀，A组有2例患者皮瓣外形欠佳，存在明显硬结及肿胀；两组并发症总发生率比较，差异无统计学意义(P>0.05)；B组颌下区积液率高于A组(P<0.05)。结论：颏部岛状皮瓣修复法与游离前臂皮瓣修复法在改善患者口腔功能、生活质量上效果相当，颏部岛状皮瓣修复法术中出血量更少，伤口美观度更好，但更易发生颌下区积液。更多还原

【Abstract】 Objective To compare the effects of different flap repair methods on the aesthetic degree of orofacial tissue defect wounds after oral cancer surgery.Methods The clinical data of 120 patients with orofacial tissue defects after oral cancer surgery who were admitted to the hospital from June 2019 to June 2023 were retrospectively analyzed.Among them,58 patients were treated with free forearm flap repair method,which was included in group A,and 62 patients were treated with chin island flap repair method,which was included in group B.The perioperative indicators,postoperative flap survival rate,patient and observer scar assessment scale (POSAS) scores were compared between the two groups.The oral function and quality of life of the two groups before and after repair were compared.The wound aesthetic satisfaction and complications of the two groups were compared.Results The operation time and hospitalization time of group B were shorter than those of group A (P<0.05),and the intraoperative blood loss of group B was less than that of group A (P<0.05).The flap preparation time and postoperative flap survival rate of the two groups were compared,and the differences were not statistically significant (P>0.05).The observer rating scale score and patient rating scale score of POSAS of group B were lower than those of group A (P<0.05).The oral appearance,swallowing ability,language function,chewing function,oral closure score and quality of life scale (SF-36) score of the two groups before and after repair were compared,and the differences were not statistically significant (P>0.05).The donor area of the skin flap was closed in one stage.One patient in each of the two groups had skin necrosis around the donor area due to excessive wound tension,and the wound healed well after debridement and drainage.The functional movement of the donor area was normal,the range of motion was good,and there was no numbness.The patients were satisfied with the functional preservation and aesthetics of the donor area.All the surviving flaps in the receiving area of group B had good appearance,soft,thin,good appearance and no obvious swelling,while 2 cases in group A had poor appearance and obvious induration and swelling.The total incidence of complications of the two groups was compared,and the difference was not statistically significant (P>0.05).The aesthetic satisfaction of wound in group B was higher than that in group A (P<0.05).However,the submandibular fluid accumulation rate of group B was higher than that of group A (P<0.05).Conclusion The chin island flap repair method and the free forearm flap repair method have similar effects on improving the oral function and quality of life of patients.The chin island flap repair method has shorter operation time and hospitalization time,less intraoperative blood loss,and better wound aesthetic degree and patient satisfaction,but it is more prone to submandibular fluid accumulation.更多还原