游离腓肠内侧动脉穿支皮瓣在舌癌术后缺损修复中的应用研究

发布时间：2018-03-29 00:30

本文选题：游离腓肠内侧动脉穿支皮瓣　切入点：舌重建　出处：《浙江大学》2014年硕士论文

【摘要】：目的：观察应用游离腓肠内侧动脉穿支皮瓣修复中小型舌癌术后缺损的临床效果,总结临床经验。方法： 2013年3月至2014年2月间6例舌癌患者,肿瘤根治术同期采用游离腓肠内侧动脉穿支皮瓣修复软组织缺损。术前采用手持多普勒检测穿支血管,予以标记定位,并设计皮瓣；术中根据缺损大小制作穿支皮瓣,记录皮瓣大小、穿支血管的数目和位置以及血管蒂长度；术后随访观察皮瓣成活情况,记录供区愈合情况及舌体功能恢复情况。结果： 6例患者所移植的皮瓣全部存活,其中1例因静脉危象而进行二次手术探查,及时清除血栓后顺利成活。6例病例平均总手术时间为6.65小时,其中平均皮瓣制备时间为65分钟。术中发现穿支情况与术前手用多普勒检查结果一致。皮瓣面积3.5cm*4cm)-(6.5cm*6cm),平均23.6cm2；血管蒂长度7-11cm,平均8.75cm；术中发现穿支数目1～2支。穿支位置距离乆纹线中点的长度为8.5～11cm,平均为9.75cm；距离小腿后正中线距离为0.1-2cm,平均距离为1.Ocm。术后随访所有患者对术后舌体外形、咀嚼及吞咽功能满意。皮瓣存活良好。患者术后均出现发音不清症状,其中两名患者症状较重。3月后复诊发音不清症状均有所改善。皮瓣供区均采取直接缝合的方法关闭,创口Ⅰ期愈合,瘢痕较隐蔽,患者除出现局部皮肤轻度感觉异常外,无肢体运动受限等其他严重的术后并发症。结论：游离腓肠内侧动脉穿支皮瓣作为一种新兴的穿支皮瓣正逐渐被引入到口腔颌面外科肿瘤术后缺损重建中。通过我科的实践证明,游离腓肠内侧动脉穿支皮瓣解剖结构稳定,皮瓣厚薄、质地适宜,术后供区并发症少,外形和语言功能恢复效果满意,非常适用于中小型舌癌术后缺损修复。
[Abstract]:Objective:. To observe the clinical effect of free medial sural artery perforator flap in repairing the defect of small and medium tongue cancer and summarize the clinical experience. Methods:. From March 2013 to February 2014, 6 patients with tongue cancer were treated with free medial sural artery perforator flap to repair soft tissue defect. The perforating branch flap was made according to the size of defect during the operation, the size of the flap, the number and location of perforating vessels and the length of vascular pedicle were recorded, and the survival of the flap was observed after operation, and the healing of donor area and the recovery of tongue body function were recorded. Results:. All the skin flaps transplanted from 6 patients survived, and one patient underwent secondary surgical exploration because of venous crisis. The average total operative time of 6 cases was 6.65 hours after prompt removal of thrombus. The average preparation time of the flap was 65 minutes. The perforating branch was found to be consistent with the preoperative Doppler examination. The flap area was 3.5cm ~ (-1) 4 cm ~ (-1) ~ 6.5 cm ~ (-1) cm ~ (-6) cm ~ (-2), the average was 23.6cm ~ (2), the pedicle length was 7-11 cm (mean 8.75 cm), the number of perforating branches was 1 ~ (2) and the perforating branch was located. The distance from the midpoint of the striate to the midpoint of the stripe is 8.5 cm, with an average of 9.75 cm, and the distance from the median line of the calf to the posterior median line is 0.1-2 cm, with an average distance of 1.Ocm. All patients were followed up with satisfactory tongue body shape, masticatory and swallowing function. The flap survived well. The symptoms of two of the patients were more serious. After 3 months of follow-up, the symptoms of unclear pronunciation were improved. The donor area of the flap was closed by direct suture, the wound healed in the first stage, and the scar was concealed. There were no other severe postoperative complications such as limited limb movement. Conclusion:. As a new perforating branch flap, the free medial sural artery perforator flap is gradually introduced into the reconstruction of oral and maxillofacial tumor defects after operation. The anatomical structure of the free medial sural artery perforating branch flap is stable through our practice. The skin flap is suitable for the repair of small and medium-sized tongue cancer with less complications and satisfactory recovery of shape and language function.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.86

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