改良前臂皮瓣在舌和口底联合缺损修复中的应用(1)
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[摘要]目的:介绍改良游离前臂皮瓣在舌、口底缺损修复中的应用效果。方法:应用改良前臂皮瓣同期游离移植修复因舌癌行扩大根治切除术后的舌、底联合缺损13例,术中根据舌、口底和牙槽骨缺损的大小设计、制备、利用改良前臂皮瓣;术中常规掀起前臂皮瓣皮岛,并保留血管蒂周围蜂窝结缔组织,形成包绕桡动静脉、头静脉的蜂窝结缔组织袖,游离移植于口内,吻合血管,再造舌并修复口底缺损。结果:前臂皮瓣全部成活,患侧颌面形态和舌外形恢复满意,舌动度较好,语音较清晰。结论:改良前臂皮瓣具有血管恒定,切取制备容易,组织量较丰富,具有较广的适应证,是同期修复舌癌术后舌和口底联合缺损的比较满意的方法,值得推广应用。
[关键词]改良前臂皮瓣;皮下组织袖;舌缺损;口底缺损
[中图分类号]R782 [文献标识码]A [文章编号]1008-6455(2010)10-1476-03
Modified free forearm flap for tongue and oral floor reconstruction
LI Jian-hu,SUN Mo-yi,ZHENG Jun,JIN Wei,ZHANG Pu,CHENG Xiao-bing,LEI De-lin
(Department of Oral and Maxillofacial Surgery, School ofStomatology,Fourth Military Medical University, Xi'an710032,Shaanxi,China)
Abstract:Objective The purpose of this study is to introduce the clinic experience of using modified free forearm flap for tongue and oral floor reconstruction.MethodsThe technique for harvestingthe skin paddle ofmodified free forearm flap was as same as the traditionalforearm flap. But the subcutaneous tissue cuffwas around the vital vessels ofmodified free forearm flap including radial artery,radial vein and cephalic vein. Modified free forearm flap was used in 13 patients with tongue and oral floor defect resulting from radical excision of carcinoma of tongue. According to the size of the defects, the modified free forearmflaps with subcutaneous tissue cuff around the vital vessels were designed,harvested and transferred into oral cavity by vascularanastomosis technique to reconstruct tongue and oral floor.Results The overall flap survival rate was 100%(all of 13 cases).The appearance of the tongue, the speaking and swallowing functions were well recovered.The satisfactory result was achieved in 13 patients. Conclusion The modified free forearm flap showed many advantages: stable blood supply,flap thickness was suitable for tongue reconstruction,and abundant soft tissue was provided for oral floor reconstruction.It is an ideal approach for tongue and oral floor defects.
Key words:Modified free forearm flap;subcutaneous tissue cuff;tongue defect;oral floor defect
舌鳞癌在口腔癌中最常见,舌癌扩大切除术及联合根治术已是治疗舌癌的有效方法。但外科手术切除造成的舌、口底组织缺损、 继发畸形和功能丧失,严重影响患者的生存质量。笔者从2005年开始采用改良的前臂皮瓣游离移植修复舌、口底缺损,在恢复舌的外形及功能方面均取得良好的效果,报道告如下。
1资料和方法
1.1临床资料:2005年10月～2009年12月在我科住院的患者共13例(男9例,女4例),年龄22～71岁,平均56岁 ......
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