头颈肿瘤整形与修复专栏·颏下皮瓣的解剖观察及在头颈肿瘤切除术后重建中的应用

Anatomical study of submental flap and its clinical application in reconstruction after tumor resection in head and neck

摘要:

目的探讨颏下皮瓣的解剖基础及临床应用效果。方法①取新鲜成人尸体８具，其中男7具，女1具；死亡年龄30~73岁，平均48岁。尸体标本经股动脉灌注加入红色乳胶后，通过解剖观察颏下动脉的走形方向、周围分支及管径等基础指标;②回顾分析应用颏下皮瓣修复头颈部肿瘤切除术后软组织缺损10例患者的临床资料，其中男8例，女2例；年龄在55~75岁，平均年龄65.5岁。6例舌癌，3例口底癌，1例下咽癌。颏下皮瓣设计4 cm×6 cm~7 cm×8 cm大小。术后随访半年，对皮瓣存活、肿瘤复发、功能恢复及患者满意度等进行评估，分析其临床应用疗效。结果①8具标本中，16侧出现颏下动脉，颏下动脉起始处管径为（1.82±0.35）mm，沿途发出(2.1±0.4)支穿支至皮肤，皮穿支的管径（0.55±0.65）mm。颏下动脉主干全长（45.51±5.22）mm，其沿途发出的分支主要有颌下腺支、颈阔肌支、二腹肌支、下颌舌骨肌支、皮肤穿支。最终在颈前正中区域与对侧血管形成血管网相互吻合;②10例手术患者应用颏下皮瓣修复头颈部肿瘤切除术后软组织缺损术后1、3、6个月随访，发现颏下皮瓣存活良好，无其他并发症，肿瘤无复发。患者咀嚼、吞咽及言语功能基本正常，仰头无受限，自身对外形和功能都比较满意。结论颏下皮瓣具有安全、制备简单等优点, 是口腔恶性肿瘤术后软组织缺损修复的一种可靠术式, 临床上可予推广应用。

关键词:头颈肿瘤|颏下皮瓣|头颈部缺损|修复重建

Abstract:

ObjectiveTo investigate the anatomical basis and clinical application effect of submental flap.Methods①Eight fresh adult corpses were collected, including 7 males and 1 female, their age of death ranged from 30 to 73 years old with an average of 48. After perfused with red latex through the femoral artery, the course and branches of the submental artery as well as their diameters were observed by dissection.②Clinical data of 10 cases of head and neck soft tissue defects repaired with the submental flap were analyzed retrospectively. Of them, eight were male and 2 were female, age ranged from 55 to 75 years old with an average of 65.5. The head and neck lesions included tongue cancer (n=6), mouth floor carcinoma (n=3) and hypopharyngeal carcinoma (n=1). The size of the submental flap ranged from 4cm×6cm to 7cm×8cm. All patients were followed up for half a year postoperatively, and the clinical efficacy was evaluated by observing the survival of flaps, tumor recurrence and functional restoration as well as patient satisfaction.Results①Of the 8 specimens, the submental artery appeared on 16 sides. The diameter of submental artery at the beginning was (1.82 ± 0.35) mm, and it sent out (2.1 ± 0.4) skin perforating branches during its course with an average diameter of (0.55 ± 0.65) mm. The average total length of the submental artery was (45.51 ± 5.22) mm. The main branches along the way included submandibular gland branch, platysma branch, digastric branch, and mandibular hyoid bone branch, as well as skin perforating branch.②Followup of the 10 patients at 1, 3, and 6 months after operation showed good survival of the flap without other complications and no tumor recurrence. Their functions of chewing, swallowing and speech recovered well without restriction of head hyperextension. All the patients were satisfied with their appearance and functional recovery.ConclusionWith advantages of safety and simple preparation, the submental skin flap is reliable for repair of soft tissue defects after tumor resection in head and neck, and is therefore worth popularization and application in clinic.

Key words:Head and neck tumor|Submental flap|Head and neck defect| Repair and reconstruction