摘要
目的探讨股内侧嵌合穿支肌皮瓣的解剖特点,以及在头颈重建领域中的应用。方法回顾性分析2015年9月至2018年12月湖南省肿瘤医院收治的74例应用游离股内侧嵌合穿支肌皮瓣移植修复的口腔恶性肿瘤患者的临床资料,其中男62例,女12例,年龄31~69岁,平均50.2岁。其中舌癌39例,牙龈癌24例,口颊癌11例;T4N1M026例,T4N0M022例,T3N1M015例,T3N2M011例。股内侧嵌合穿支肌皮瓣穿支血管蒂动脉与甲状腺上动脉吻合,伴行静脉与甲状腺上静脉或颈内静脉吻合。术中记录肿瘤根治术后遗留的软组织缺损大小、游离股内侧皮瓣长、宽、厚以及血管蒂长度和血管蒂来源。术后随访观察皮瓣成活情况、功能状态和供区恢复情况。结果口腔恶性肿瘤患者行肿瘤根治术后遗留的继发软组织缺损大小为4.0 cm×3.5 cm^9.0 cm×5.5 cm,全部应用游离股内侧嵌合穿支肌皮瓣移植修复,皮瓣长(12.5±0.4)cm、宽(7.2±0.4)cm、厚(3.5±0.2)cm,血管蒂长度为(8.6±0.4)cm。所有病例中股内侧穿支恒定存在,具体血管蒂来源分为6类,股内侧肌和长收肌之间的股动脉蒂肌间隔穿支4例(5.4%),长收肌的股深动脉蒂肌皮穿支6例(8.1%),股薄肌的股深动脉蒂肌皮穿支16例(21.6%),股薄肌和大收肌之间的股深动脉蒂肌间隔动脉穿支9例(12.2%),大收肌的股深动脉蒂肌皮穿支29例(39.2%),半膜肌的股深动脉蒂肌皮穿支10例(13.5%)。74例皮瓣全部存活,供区创面均直接闭合,随访12~36个月,皮瓣外观满意,吞咽、言语功能满意,供区仅遗留线性瘢痕,大腿功能未见明显影响。4例发生肿瘤局部复发,再次行肿瘤根治术并以带蒂胸大肌皮瓣转移修复后效果良好。结论股内侧嵌合穿支肌皮瓣组织量丰富,血管解剖恒定,可选择设计方案多,皮瓣供区损伤小,是头颈肿瘤术后重建的理想选择。
Objective To explore the anatomical classification and application of chimeric myocutaneous medial thigh perforator(MTP)flap in head and neck reconstruction.Methods From September 2015 to December 2018,the clinical data of 74 patients(62 males and 12 females,age ranging from 31 to 69 years,with a mean age of 50.2 years)with oral tumor,who underwent radical resection in Hunan Cancer Hospital,including 39 cases of tongue carcinoma,24 cases of gingival carcinoma and 11 cases of buccal cancer,26 cases of stage T4N1M0,22 cases of stage T4N0M0,15 cases of stage T3N1M0,and 11 cases of stage T3N2M0 were retrospectively analyzed in this work.The arteries and the veins contributing to MTP were anastomosed respectively with superior thyroid arteries,while the venae comitans were anastomosed with superior thyroid venae veins or internal jugular venae vein.The size of soft tissue defect,the length,width and thickness of free medial thigh flap,the length and source of vascular pedicle were recorded.The flap survival,functional status and donor area recovery were observed.Results The postoperative defects in size ranged from 4.0 cm×3.5 cm to 9.0 cm×5.5 cm,which were reconstructed by free chimeric myocutaneous MTP flaps.The mean length of MTP flaps was(12.5±0.4)cm,the mean width was(7.2±0.4)cm,the mean thickness was(3.5±0.2)cm.The mean pedicle length was(8.6±0.4)cm.The perforators existed consistently in all cases,and the vascular origins were classified into 6 types.There were 4 cases(5.4%)of the perforating branches originating from femoral artery between the medial femoris and the adductor longus,6 cases(8.1%)of the perforating branches of the profunda femoral artery from the adductor longus,16 cases(21.6%)of the perforating branches of the profunda femoral artery from the gracilis,9 cases(12.2%)of the perforating branches of the profunda femoral artery between the gracilis and the adductor longus,29 cases(39.2%)of the perforating branches of the profunda femoral artery from the adductor longus,and 10 cases(13.5%)of branches of the profunda femoral artery from the semimembranous muscle.All 74 flaps survived uneventfully.The donor sites and recipient sites were closed directly in all cases.All patients were followed up for 12-36 months with satisfied esthetic and functional results.Only linear scars were left in the donor sites,and the thigh function was not affected.Local recurrence happened in 4 cases,which were treated with radical resection and the left defects were reconstructed with pedicled pectoral major myocutaneous flaps.Conclusion The chimeric myocutaneous MTP flap has good color match and texture,with abundant tissue,and consistent blood supply,and it can be harvested in various forms while leaving minimal morbidity at donor site,being an idea choice for reconstruction after surgery of oral cancer.
作者
宋达疆
彭文
李赞
周晓
章一新
彭小伟
周波
吕春柳
伍鹏
唐园园
Song Dajiang;Peng Wen;Li Zan;Zhou Xiao;Zhang Yixin;Peng Xiaowei;Zhou Bo;Lyu Chunliu;Wu Peng;Tang Yuanyuan(Department of Oncology Plastic Surgery,Hunan Cancer Hospital,Changsha 410008,China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People′s Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2020年第5期483-486,487-489,共7页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
湖南省自然科学基金(2018JJ2241、2018JJ2242)
湖南省肿瘤整形外科临床医学研究中心平台建设专项资助(2013TP4087)
湖南省自然科学基金科卫联合基金项目(2018JJ6028)
湖南省卫生健康委员会科研计划课题项目(B2019092)
长沙市科技计划基础研究项目(kq1901074、kq1901077)。
关键词
股薄肌
股内侧肌穿支皮瓣
头颈部肿瘤
嵌合皮瓣
肌皮瓣
Gracilis muscle
Perforating branch flap of medial vastus muscle
Head and neck neoplasms
Chimeric flap
Myocutaneous flap
