前臂皮瓣在口腔鳞癌术后缺损修复中的临床应用
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摘要
目的:对前臂皮瓣外形实施几何改进,探讨其临床运用价值。方法:12例口腔鳞癌(颊癌8例、舌癌3例、口底癌1例)原发灶切除后,前臂皮瓣同期修复重建,根据组织缺损的形状及大小来设计切取皮瓣,经移植、血管吻合重建肿瘤切除后的创面。结果:改良设计的前臂皮瓣面积和外形达到受区缺损的需求,外形良好,术中无需过多的修整,术后皮瓣均成活,术后定期随访6～12个月,肿瘤均无转移及复发,皮瓣外形满意,患者语言、吞咽功能恢复良好。结论:改良几何设计前臂皮瓣的外形,能够最优化的修复软组织缺损,恢复和面部软组织的外形及功能,设计可靠安全,值得推广。
Objective: Radial forearm free flaps were so designed and harvested that they could be tailored to the shape of the tissue defects. Methods: Twelve cases with tissue defects underwent immediate reconstruction with modified redial forearm flaps according the size and shape of the defects after removal of the primary caicinoma. Modified forearm free flap were transferred into oral cavity by vascular anastomosis technique. Results: Modified radial forearm free flaps matched all the defects well and all the flaps survived with ideal aesthetic outcomes. All the patients were followed about six to twelve months and tumor recunence was not found. Satisfactory postoperative appearance was achieved. Conclusion:Modified radial forearm flap design is an ideal technique according to maxillofacial soft tissue defect,which can restore both the maximum facial appearance and function, and can strikingly improve the quality of life.
Objective: Radial forearm free flaps were so designed and harvested that they could be tailored to the shape of the tissue defects. Methods: Twelve cases with tissue defects underwent immediate reconstruction with modified redial forearm flaps according the size and shape of the defects after removal of the primary caicinoma. Modified forearm free flap were transferred into oral cavity by vascular anastomosis technique. Results: Modified radial forearm free flaps matched all the defects well and all the flaps survived with ideal aesthetic outcomes. All the patients were followed about six to twelve months and tumor recunence was not found. Satisfactory postoperative appearance was achieved. Conclusion:Modified radial forearm flap design is an ideal technique according to maxillofacial soft tissue defect,which can restore both the maximum facial appearance and function, and can strikingly improve the quality of life.
引文
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[2]李超,李春华,陈建超,等."Chinese flap"-头颈肿瘤修复手段中的中国制造[J].肿瘤预防与治疗,2013,26(1):4-6.
[3]Medard de Chardon v,BalagIler T,Chigllon_sieard B,et al.The radial forearm free flap:a review of microsurgical options[J].J Plast Reconstr Aesthet Surg,2009,62(1):5-10.
[4]Ichinose A,Tahara S H,Yokoo S,et al.Importance of the deep vein in the drainage of a radial forearm flap:a haemodynamic study[J].Scand J Plast Reconstr Surg Hand Surg,2003,37(37):145-149.
[5]Knobloch K,Tbmaszek S,Busch KH,et al.Palmar microcirculation does not deteriomte 2 years after radial artery harvesting implications for reconstmctive free forearm flap transfer[J].Langen-beck's Arch Surg,2007,392(3):315-322.
[6]Ichinose A,Tahara S,Terashi H,et al.Importance of the deep vein in the drainage of a radial forearm flap:ahaemodynamic study[J].Scand J Plast Reconstr Surg Hand Surg,2003,37(37):145-149.
[7]Hekner DD,Abbink JH,Van EsILl,et al.Donor-site morbidity ofthe radial forearm free flap versus the ulnar forearm free flap[J].Plast Reconstr Surg,2013,132(2):387-393.
[8]Schwarzer C,Mücke T,Wolff K D,et al.Donor site morbidity and flap perfusion of subfascial and suprafascial radial forearm flaps:A randomized prospective clinical comparison trial[J].J Craniomaxillofac Surg,2016,44(9):1299-1304.
[9]张志愿,俞光岩,孙坚,等.口腔颌面外科学[M].北京:人民卫生出版社,2012:540-540.
[10]Garg R K,Wieland A M,Poore S O,et al.The radial forearm snake flap:A novel approach to oral cavity and oropharyngeal reconstruction that reduces forearm donor site morbidity[J].Microsurgery,2017,37(1):6-11.
[11]Riecke B,Kohlmeier C,Assaf A T,et al.Prospective biomechanical evaluation of donor site morbidity after radial forearm free flap[J].Br J Oral Maxillofac Surg,2016,54(2):181-186.
[12]Bashir M A,Fung V,Kernohan M D,et al."Z-plasty"modification of ulnar-based fasciocutaneous flap for closure of the radial forearm flap donor defect[J].Annals Plast Surg,2010,64(1):22-23.
[13]Hsieh C H,Kuo Y R,Yao S F,et al.Primary closure of radial forearm flap donor defects with a bilobed flap based on the fasciocutaneous perforator of the ulnar artery[J].Plastic Reconstr Surgery,2004,113(5):1355-60.
[14]Akyürek M,Safak T.Direct closure of radial forearm freeflap donor sites by double-opposing rhomboid transposition flaps:case report[J].J Reconstr Microsurg,2002,18(1):33-36.
[15]Park T J,Kim H J,Ahn K M.Double-layered collagen graft to the radial forearm free flap donor sites without skin graft[J].Maxillofacial Plastic Reconstr Surg,2015,37(1):45.
[16]Byun S H,Ahn K M,Kim S M,et al.Functional and cosmetic outcome after closure of radial forearm free flap donor defect with porcine collagen membrane[J].J craniomaxillofacial Surg,2016,44(5):527-532.
[2]李超,李春华,陈建超,等."Chinese flap"-头颈肿瘤修复手段中的中国制造[J].肿瘤预防与治疗,2013,26(1):4-6.
[3]Medard de Chardon v,BalagIler T,Chigllon_sieard B,et al.The radial forearm free flap:a review of microsurgical options[J].J Plast Reconstr Aesthet Surg,2009,62(1):5-10.
[4]Ichinose A,Tahara S H,Yokoo S,et al.Importance of the deep vein in the drainage of a radial forearm flap:a haemodynamic study[J].Scand J Plast Reconstr Surg Hand Surg,2003,37(37):145-149.
[5]Knobloch K,Tbmaszek S,Busch KH,et al.Palmar microcirculation does not deteriomte 2 years after radial artery harvesting implications for reconstmctive free forearm flap transfer[J].Langen-beck's Arch Surg,2007,392(3):315-322.
[6]Ichinose A,Tahara S,Terashi H,et al.Importance of the deep vein in the drainage of a radial forearm flap:ahaemodynamic study[J].Scand J Plast Reconstr Surg Hand Surg,2003,37(37):145-149.
[7]Hekner DD,Abbink JH,Van EsILl,et al.Donor-site morbidity ofthe radial forearm free flap versus the ulnar forearm free flap[J].Plast Reconstr Surg,2013,132(2):387-393.
[8]Schwarzer C,Mücke T,Wolff K D,et al.Donor site morbidity and flap perfusion of subfascial and suprafascial radial forearm flaps:A randomized prospective clinical comparison trial[J].J Craniomaxillofac Surg,2016,44(9):1299-1304.
[9]张志愿,俞光岩,孙坚,等.口腔颌面外科学[M].北京:人民卫生出版社,2012:540-540.
[10]Garg R K,Wieland A M,Poore S O,et al.The radial forearm snake flap:A novel approach to oral cavity and oropharyngeal reconstruction that reduces forearm donor site morbidity[J].Microsurgery,2017,37(1):6-11.
[11]Riecke B,Kohlmeier C,Assaf A T,et al.Prospective biomechanical evaluation of donor site morbidity after radial forearm free flap[J].Br J Oral Maxillofac Surg,2016,54(2):181-186.
[12]Bashir M A,Fung V,Kernohan M D,et al."Z-plasty"modification of ulnar-based fasciocutaneous flap for closure of the radial forearm flap donor defect[J].Annals Plast Surg,2010,64(1):22-23.
[13]Hsieh C H,Kuo Y R,Yao S F,et al.Primary closure of radial forearm flap donor defects with a bilobed flap based on the fasciocutaneous perforator of the ulnar artery[J].Plastic Reconstr Surgery,2004,113(5):1355-60.
[14]Akyürek M,Safak T.Direct closure of radial forearm freeflap donor sites by double-opposing rhomboid transposition flaps:case report[J].J Reconstr Microsurg,2002,18(1):33-36.
[15]Park T J,Kim H J,Ahn K M.Double-layered collagen graft to the radial forearm free flap donor sites without skin graft[J].Maxillofacial Plastic Reconstr Surg,2015,37(1):45.
[16]Byun S H,Ahn K M,Kim S M,et al.Functional and cosmetic outcome after closure of radial forearm free flap donor defect with porcine collagen membrane[J].J craniomaxillofacial Surg,2016,44(5):527-532.