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目的总结采用背阔肌肌皮瓣联合胸锁乳突肌肌皮瓣修复局部晚期口腔癌根治术后缺损的临床疗效。方法2005年3月-2008年7月,收治3例局部晚期口腔癌术后缺损女性患者,年龄51～67岁。其中颊黏膜癌1例,口底癌2例;分期分别为T4N2M0、T4N0M0及T4N3M0。病程3个月～3年。术中肿瘤切除后缺损范围为6.0cm×4.5cm～8.0cm×7.0cm,采用大小为4.0cm×3.5cm～5.0cm×2.5cm同侧带蒂背阔肌肌皮瓣及大小为3.5cm×2.0cm～4.0cm×2.5cm胸锁乳突肌肌皮瓣一期修复缺损。供区均采用游离周围组织后直接行减张缝合,并放置负压引流装置。结果术后1周1例疣状细胞癌患者皮岛出现部分皮肤坏死,采用旷置疗法后约2周痂下愈合;2例皮瓣顺利成活,切口均Ⅰ期愈合。供区切口均Ⅰ期愈合。3例均获随访,随访时间6～18个月。术后进食正常,修复区面部外形基本满意。随访期间均未见肿瘤复发和转移。结论背阔肌肌皮瓣联合胸锁乳突肌肌皮瓣组织量充分,是修复晚期口腔癌术后缺损的有效方法之一。
Objective To summarize the clinical effects of latissimus dorsi myocutaneous flap combined with sternocleidomastoid myocutaneous flap in the repair of locally advanced oral cancer after radical operation. Methods From March 2005 to July 2008, 3 female patients with locally advanced postoperative oral cancer with a defect of 51 to 67 years old were enrolled. Including buccal mucosa in 1 case, 2 cases of mouth cancer; staging were T4N2M0, T4N0M0 and T4N3M0. Duration of 3 months to 3 years. Intraoperative tumor excision range of 6.0cm × 4.5cm ~ 8.0cm × 7.0cm, using the size of 4.0cm × 3.5cm ~ 5.0cm × 2.5cm ipsilateral dorsal latissimoderma muscle flap and the size of 3.5cm × 2.0cm ~ 4.0cm × 2.5cm sternocleidomastoid myocutaneous flap a defect repair. For the area are free after the surrounding tissue directly suture tension reduction, and placed negative pressure drainage device. Results One case of verruciform cell carcinoma showed partial dermal necrosis in the dermatome at 1 week after operation. The wounds healed after about 2 weeks of excision. The flaps survived successfully in 2 cases and all the incisions healed in the first stage. District incision healed first. All patients were followed up for 6-18 months. Normal postoperative eating, repair area facial shape basically satisfied. No tumor recurrence and metastasis were observed during follow-up. Conclusion The latissimus dorsi myocutaneous flap combined with sternocleidomastoid myocutaneous flap is an effective method to repair postoperative defect of advanced oral carcinoma.