摘要
目的：探讨颈阔肌肌皮瓣在颊部恶性肿瘤术后修复组织缺损的方法可行性,指导临床实践。
方法：20例颊部恶性肿瘤切除后软组织缺损同期应用颈阔肌肌皮瓣修复,其中男性13例,女性7例,年龄最小38岁,最大81岁,平均年龄为56岁,肿瘤分期分别为T1N0M0 2例、T2N0M0 5例、T3N0M0 3例、T3N1M0 2例,T3N2M0 1例,T4N0M0 6例、T4N1M0 1例,术前行放射治疗1例,术后行放射治疗17例,颈阔肌肌皮瓣面积最小为3.5×3.0cm2,最大为6.5×6.0cm2。
结果：15例患者颈阔肌肌皮瓣完全存活,4例发生部分坏死,1例发生感染,没有皮瓣完全坏死者,经过3个月-3年6个月的随访发现,皮瓣成活率高,并发症发生率较低,受区功能正常,张口度恢复情况良好,供区外形良好,无明显功能受限。且术后行放射治疗者未出现严重张口受限等并发症。
结论：颈阔肌肌皮瓣制备方便,皮瓣成活率高,并发症发生率较低,修复后张口度恢复情况良好,对语言、进食、转颈等功能无明显影响,供区疤痕较为隐蔽。并且术后放射治疗不增加皮瓣坏死等并发症的发生率。适用于颊癌切除后中小型软组织缺损的修复。
Purpose:To assess the reliability of the platysma myocutenous flap for reconstruction of buccal defects following cancer surgery.
Methods:20 buccal defects were repaired with platysma myocutaneous flaps after resection of the buccal malignant tumor. Among them,13 patients were male and 7 patients were female, the age of the patients ranged from 38 years to 81 years, and the mean age was 56 years.2 patients were classified as T1 NoMo,5 as T2N0M0,3 as T3N0M0,2 as T3N1M0,1 as T3N2Mo,6 as T4NoMo,1 as T4N1M0.1 patient had preoperative radiotherapy and 17 patients accepted postoperative radiotherapy. The size of the playtsma myocutaneous flaps ranged from 3.5×3.0m2 to 6.5×6.0cm2.
Results:The postoperative outcome of the platysma myocutaneous flaps was survival in 20 cases, including 15 cases without any complication,4 cases with partial necrosis, and lcase with infection. All patients were followed up from 3 months to 3.5 years. Most flaps were survived with satisfactory function and outline, without severe limited mouth opening, and the appearance of donor site was acceptable. And the postoperative radiotherapy did not increase the incidence of the complications.
Conclusions:The platysma myocutaneous flap is harvested easily and rapidly. And the success rate is high and the rate of the complications is low. The functional and esthetic outcome is good. Postoperative radiotherapy do not affect the survival rates of the flap obviously. In conclusion the platysma myocutaneous flap has clinical value in reconstruction of small and medium-sized buccal defects after the resection of buccal malignant tumor.
引文
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