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目的总结应用后桡侧副动脉(posterior radial collateral artery,PRCA)穿支嵌合瓣修复舌癌术后软组织缺损的临床效果。方法 2011年8月-10月,收治舌部鳞状细胞癌男性患者5例。年龄43～71岁,平均59岁。病程25～60 d,平均42 d。舌癌病灶扩大切除后,3例1/3舌及口底组织缺损,2例1/2舌及口底组织缺损。应用PRCA设计制备游离延展上臂外侧皮瓣(extended lateral arm free flap,ELAFF)与肱三头肌肌瓣(triceps muscle flap,TMF)形成嵌合瓣,一期修复舌部软组织缺损。ELAFF切取范围为7 cm×5 cm～9 cm×5 cm,TMF为3 cm×3 cm～4 cm×4 cm。供区直接拉拢缝合。结果术后嵌合瓣均顺利成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合。患者术后均获6个月随访。术后舌体外形及运动良好,发音较清晰,吞咽无障碍。随访期间肿瘤均无复发。供区肘关节功能正常,局部有轻微麻木感。结论应用PRCA穿支制备游离ELAFF及TMF并形成嵌合瓣修复舌部软组织缺损,其血供可靠,手术操作简便,能提高修复效果,并发症少,是舌癌切除后缺损修复的较好选择之一。
Objective To summarize the clinical effect of posterior radial collateral artery (PRCA) perforating chimeric flap for repairing soft tissue defects of tongue cancer. Methods From August to October in 2011, 5 cases of male squamous cell carcinoma of the tongue were treated. Age 43 ~ 71 years old, average 59 years old. Duration of 25 ~ 60 d, an average of 42 d. Tongue cancer lesions enlarged after resection, 3 cases of 1/3 tongue and mouth tissue defects, 2 cases of 1/2 tongue and mouth tissue defects. PRCA was used to design and manufacture ELSA with extended triceps muscle flap (TMF) to repair the soft tissue defects in the first phase. The cut-off range of ELAFF is 7 cm × 5 cm-9 cm × 5 cm and TMF is 3 cm × 3 cm-4 cm × 4 cm. For the area directly draw suture. Results The chimeric flaps survived successfully and the wounds healed in the first stage. All the wounds were healed by first intention. Patients were followed up for 6 months after surgery. Postoperative tongue shape and good movement, articulation clearer, swallowing accessibility. No recurrence of tumor during follow-up. Elbow area for the normal function, some slight numbness. Conclusions The preparation of free ELAFF and TMF by PRCA perforation and the formation of chimeric flap for the repair of tongue soft tissue defect are reliable for blood supply and simple operation, which can improve the repair effect and reduce the complications. It is a better choice for repair of tongue cancer after resection one.