改良桡侧前臂游离皮瓣（MRFFF）在口腔颌面部恶性肿瘤切除缺损即刻修复中的应用
发布时间：2018-11-11 19:34
【摘要】：目的:介绍眼镜式游离皮瓣(Glasses-shaped flap)一种改良的桡侧前臂游离皮瓣(Modified radial forearm free flap,MRFFF)的技术要点,并通过比较传统桡侧前臂游离皮瓣(Traditional radial forearm free flap,TRFFF)和改良桡侧前臂游离皮瓣在口腔颌面部恶性肿瘤切除缺损即刻修复及功能重建的临床应用,探讨眼镜式游离皮瓣的适应症、可靠性、优点和技术要点。方法:收集出院日期在2016年1月1日至2016年12月31日于浙江大学医学院附属第二医院滨江院区口腔领面外科行" 口腔颌面部恶性肿瘤扩大切除术"并同期应用桡侧前臂游离皮瓣修复缺损的18例病例相关资料并作随访,1例失访。其中5例应用传统桡侧前臂游离皮瓣修复缺损,其余13例均应用改良桡侧前臂游离皮瓣。比较两组病例中皮瓣存活率、供区形态和功能、受区形态和功能、患者满意度等。结果:(1)MRFFF组皮岛总大小为4cm*3.5cm至6cm*6cm,均保留头静脉于供区,桡动脉血管蒂长度为8cm至12cm,均长为9.4cm;TRFFF组皮瓣大小为4cm*5cm至6.5cm*7cm,皮瓣均包括桡动静脉和头静脉,其中桡动脉血管蒂长度从10cm至14cm,均长为12.8cm。(2)MRFFF组供区均实现潜行分离后直接拉拢缝合关闭供区缺损,TRFFF组供区均采用了游离皮片移植关闭缺损。所有病例的供区缝合处均愈合良好,MRFFF组术后未见创缘裂开,而TRFFF组移植皮片均存活,未见明显感染坏死。(3)MRFFF组均采用桡动脉和2条桡静脉为吻合血管,分别与面动脉(或者甲状腺上动脉)和面总静脉(或其属支)及颈外静脉吻合。TRFFF组均采用桡动脉和头静脉为吻合血管,分别与面动脉(或甲状腺上动脉)和面总静脉(或其属支)或颈外静脉吻合。MRFFF组皮瓣移植后存活率为100%(13/13),TRFFF组皮瓣移植后存活率为80%(4/5),其中失败的1例TRFFF同时伴重建钛板排异情况。(4)术后随访显示,MRFFF组和TRFFF组术后患者生活质量均较好。两组患者对供区外观满意度均高。两组均有病例出现术后供区局部麻木情况(术后3月以上仍旧麻木):MRFFF组:前臂麻木感4例(4/12),大拇指及虎口处麻木4例(4/12);TRFFF组前臂术区麻木2例(2/5),大拇指及虎口处麻木4例(4/5)。所有17例随访的前臂游离皮瓣患者术后手腕及手指运动功能受损情况均未达到影响日常生活程度。结论:眼镜式游离皮瓣可以有效修复最大可达6cm*6cm的口腔颌面部软组织缺损。该皮瓣采用桡动脉及两条伴行静脉为吻合血管,皮瓣存活率达100%(13/13)。相较于TRFFF,MRFFF主要具有以下优点:(1)实现供区直接拉拢缝合,避免了游离皮片移植;(2)由于不需要头静脉作血管吻合,皮岛完全设计在前臂掌侧,相对隐蔽,提高了术后美观度;(3)减少了对桡神经浅支和前臂外侧皮神经损伤的风险,从而降低了感觉功能损害。
[Abstract]:Objective: to introduce the technical essentials of a modified radial forearm free flap (Modified radial forearm free flap,MRFFF) of the spectacle free forearm flap (Glasses-shaped flap), and to compare (Traditional radial forearm free flap, with the traditional radial forearm free flap. TRFFF) and modified radial forearm free flap were used in immediate repair and functional reconstruction of malignant tumor in oral and maxillofacial region. The indications, reliability, advantages and technical points of spectacle free flap were discussed. Methods: extensive excision of oral and maxillofacial malignant tumors was performed at Binjiang Hospital, second affiliated Hospital, School of Medicine, Zhejiang University from January 1, 2016 to December 31, 2016. The data of 18 cases of radial forearm free flap repair defect were followed up. One case lost the visit. The defect was repaired by traditional radial forearm free flap in 5 cases and modified radial forearm free flap in 13 cases. The flap survival rate, donor area morphology and function, recipient area morphology and function, patient satisfaction were compared between the two groups. Results: (1) in MRFFF group, the total size of skin island was from 6 cm to 6 cm, and the length of pedicle of radial artery was from 8cm to 12 cm, and the length of pedicle of radial artery was 9.4 cm. In TRFFF group, the size of the flap ranged from 6.5 cm to 6.5 cm ~ 7 cm. The flap included radial arteriovenous and cephalic vein, and the pedicle length of radial artery was from 10cm to 14 cm. The average length of donor area was 12.8 cm 路(2) the donor area of MRFFF group was closed and closed directly after subsurface separation, and free skin graft was used to close the defect in TRFFF group. In all cases, the suture site of donor area healed well, and there was no laceration in the MRFFF group, while in the TRFFF group, the grafts survived without obvious infection and necrosis. (3) the radial artery and two radial veins were used as anastomotic vessels in the MRFFF group. They were anastomosed with facial artery (or superior thyroid artery), common facial vein (or its branches) and external jugular vein respectively. Radial artery and cephalic vein were used as anastomoses in TRFFF group. Anastomosis with the facial artery (or superior thyroid artery) and the common facial vein (or its branches) or external jugular vein respectively. The survival rate of the flap in the MRFFF group was 100% (80% (4 / 5) in 13 / 13), TRFFF group). (4) the postoperative follow-up showed that the quality of life of the patients in the MRFFF group and TRFFF group was better than that in the TRFFF group. The patients in both groups were satisfied with the appearance of donor area. There were local numbness of donor area in both groups (): MRFFF group: 4 cases (4 / 12) of forearm numbness, 4 cases (4 / 12) of thumb and tiger mouth numbness); In TRFFF group, there were 2 cases of forearm numbness (2 / 5), 4 cases of thumb and tiger mouth numbness (4 / 5). All 17 cases of forearm free flap were not affected by the degree of daily life. Conclusion: the spectacle free flap can effectively repair the oral and maxillofacial soft tissue defects up to 6cm*6cm. The flap was anastomosed with radial artery and two accompanying veins. The survival rate of the flap was 100% (13 / 13). Compared with TRFFF,MRFFF, it has the following advantages: (1) realize direct suture of donor area and avoid free skin graft; (2) because there is no need for vascular anastomosis of the cephalic vein, the skin island is completely designed on the palmar side of the forearm, which is relatively hidden, and improves the aesthetic degree after operation. (3) the risk of injury to superficial branch of radial nerve and lateral cutaneous nerve of forearm was reduced, and the damage of sensory function was reduced.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.8
，
本文编号：2325911
[Abstract]:Objective: to introduce the technical essentials of a modified radial forearm free flap (Modified radial forearm free flap,MRFFF) of the spectacle free forearm flap (Glasses-shaped flap), and to compare (Traditional radial forearm free flap, with the traditional radial forearm free flap. TRFFF) and modified radial forearm free flap were used in immediate repair and functional reconstruction of malignant tumor in oral and maxillofacial region. The indications, reliability, advantages and technical points of spectacle free flap were discussed. Methods: extensive excision of oral and maxillofacial malignant tumors was performed at Binjiang Hospital, second affiliated Hospital, School of Medicine, Zhejiang University from January 1, 2016 to December 31, 2016. The data of 18 cases of radial forearm free flap repair defect were followed up. One case lost the visit. The defect was repaired by traditional radial forearm free flap in 5 cases and modified radial forearm free flap in 13 cases. The flap survival rate, donor area morphology and function, recipient area morphology and function, patient satisfaction were compared between the two groups. Results: (1) in MRFFF group, the total size of skin island was from 6 cm to 6 cm, and the length of pedicle of radial artery was from 8cm to 12 cm, and the length of pedicle of radial artery was 9.4 cm. In TRFFF group, the size of the flap ranged from 6.5 cm to 6.5 cm ~ 7 cm. The flap included radial arteriovenous and cephalic vein, and the pedicle length of radial artery was from 10cm to 14 cm. The average length of donor area was 12.8 cm 路(2) the donor area of MRFFF group was closed and closed directly after subsurface separation, and free skin graft was used to close the defect in TRFFF group. In all cases, the suture site of donor area healed well, and there was no laceration in the MRFFF group, while in the TRFFF group, the grafts survived without obvious infection and necrosis. (3) the radial artery and two radial veins were used as anastomotic vessels in the MRFFF group. They were anastomosed with facial artery (or superior thyroid artery), common facial vein (or its branches) and external jugular vein respectively. Radial artery and cephalic vein were used as anastomoses in TRFFF group. Anastomosis with the facial artery (or superior thyroid artery) and the common facial vein (or its branches) or external jugular vein respectively. The survival rate of the flap in the MRFFF group was 100% (80% (4 / 5) in 13 / 13), TRFFF group). (4) the postoperative follow-up showed that the quality of life of the patients in the MRFFF group and TRFFF group was better than that in the TRFFF group. The patients in both groups were satisfied with the appearance of donor area. There were local numbness of donor area in both groups (): MRFFF group: 4 cases (4 / 12) of forearm numbness, 4 cases (4 / 12) of thumb and tiger mouth numbness); In TRFFF group, there were 2 cases of forearm numbness (2 / 5), 4 cases of thumb and tiger mouth numbness (4 / 5). All 17 cases of forearm free flap were not affected by the degree of daily life. Conclusion: the spectacle free flap can effectively repair the oral and maxillofacial soft tissue defects up to 6cm*6cm. The flap was anastomosed with radial artery and two accompanying veins. The survival rate of the flap was 100% (13 / 13). Compared with TRFFF,MRFFF, it has the following advantages: (1) realize direct suture of donor area and avoid free skin graft; (2) because there is no need for vascular anastomosis of the cephalic vein, the skin island is completely designed on the palmar side of the forearm, which is relatively hidden, and improves the aesthetic degree after operation. (3) the risk of injury to superficial branch of radial nerve and lateral cutaneous nerve of forearm was reduced, and the damage of sensory function was reduced.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.8
，
本文编号：2325911
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