游离臂外侧嵌合肌皮瓣修复口颊癌术后口颊缺损的临床分析

Free lateral arm chimeric myocutaneous flap for repair of defect after surgical resection of oral buccal carcinoma

摘要:

目的 探讨采用不同形式游离臂外侧嵌合肌皮瓣修复口颊癌术后口颊缺损的效果。方法2006年1月—2017年9月应用臂外侧嵌合肌皮瓣修复10例口颊癌患者根治术后口颊缺损，男9例，女1例；年龄36~67岁，平均年龄44.5岁。病理类型均为鳞状上皮细胞癌， TNM 分期其中T4N0M0 4例，T4N1M0 3例，T3N1M03例。病程4~26个月，平均9.8个月。口颊缺损6.0 cm×3.0 cm～8.5 cm×4.5 cm大小，皮瓣轴线为三角肌止点至肱骨外上髁连线。根据缺损实际情况设计皮瓣修复口颊创面，根据血管蒂肌支发出情况和口底腔隙具体设计切取肱肌或肱三头肌肌瓣用于填补口底腔隙。结果臂外侧嵌合肌皮瓣血管蒂长度为(7.7±0.4) cm。桡侧副动脉后支的皮穿支共有17支，其中2支穿支型为7例，1支穿支型为3例，全部携带于皮瓣内，皮岛面积为6.0 cm×3.0 cm～8.5 cm×4.5 cm，肌瓣为3.0 cm×2.0 cm×2.0 cm～4.5 cm×2.5 cm×2.0 cm大小，其中7例为肱三头肌肌瓣，3例为肱肌肌瓣。10例嵌合穿支肌皮瓣全部存活，供区均直接闭合。随访12～59个月，平均25.7个月，重建口颊外形不臃肿，无毛发生长，功能满意，肿瘤局部无复发；2例发生颈部淋巴结转移。供区仅遗留线性瘢痕，上臂功能未见明显影响。结论臂外侧嵌合肌皮瓣可以作为口颊癌术后口颊缺损修复的方法选择之一。 ［Chinese Journal of OtorhinolaryngologySkull Base Surgery，2020，26（1）：00-00］

关键词:口颊癌|缺损修复|穿支皮瓣|桡侧副动脉|嵌合瓣| 游离皮瓣移植

Abstract:

ObjectiveTo investigate the application of free lateral arm chimeric myocutaneous flap for the repair of defect after surgical resection of oral buccal carcinoma.MethodsFrom Jan 2006 to Sept 2017，10 patients suffering from oral buccal carcinoma received radical resection and onestaged repair of defect by different types of free lateral arm chimeric myocutaneous flap. Of them, nine were female and one was female, aged from 36 to 67 years old with an average of 44.5. The pathological diagnosis was squamous cell carcinoma in all cases. The TNM stage included T4N0M0 (n=4)，T4N1M0 (n=3)，and T3N1M0 (n=3). Their course of disease ranged from 4 to 26 months with an average of 9.8. The size of the buccal mucosa defect ranged from 6.0 cm×3.0 cm to 8.5 cm×4.5 cm, and the axis of the flap was the line from the insertion of deltoid muscle to the lateral epicondyle of humerus. To repair buccal defect, the flap was designed according to the size and shape of buccal mucosa defect. The mouth floor cavity was filled with muscular flap designed and harvested based on the defect size of the cavity and the distribution of the muscular branches of the vascular pedicle, and the brachial muscle or triceps muscle was chosen as donor site．ResultsThe length of vascular pedicle of lateral arm chimeric myocutaneous flap was (7.7±0.4) cm．Of them, seventeen cutaneous perforating branches originated from the posterior branch of radial collateral artery including type of 2 branches in 7 cases and type of 1 branch in 3 with all the perforating branches carried in the flap. The area of skin island ranged from 6.0 cm×3.0 cm to 8.5 cm×4.5 cm, and the size of muscle flap was 3.0 cm × 2.0 cm × 2.0 cm to 4.5 cm×2.5 cm×2.0 cm. Among them, triceps brachii muscle flap was adopted in 7 cases and brachial muscle flap in 3. All 10 chimeric perforator flaps survived uneventfully and the donor site was closed directly in all cases. All patients were followed up for 12 to 59 months (25.7 months on average). The reconstructed buccal mucosa was not bulky without hair growth. The function was satisfactory. No local recurrence happened in all cases with cervical lymph node metastasis in 2. Only linear scar was left in the donor sites, the function of arms was not affected.ConclusionThe lateral arm chimeric myocutaneous flap is an option for the repair of defect after surgical resection of oral buccal carcinoma．

Key words:Buccal mucosal squamous cell carcinoma|Defect repair| Perforator flap| Radial collateral artery| Chimeric myocutaneous flap| Free flap transplantation