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目的 :探讨游离延展上臂外侧皮瓣修复口腔癌术后软组织缺损的临床疗效。方法 :2011年1月—2013年12月,应用游离延展上臂外侧皮瓣一期修复15例口腔癌扩大切除术造成的软组织缺损,术前应用多普勒血流探测仪测量桡侧副动脉无变异后,根据其走行以及术中软组织缺损的面积、形态设计皮瓣,皮瓣均越过肱骨外上髁,面积为4 cm×5 cm~11 cm×5 cm,血管蒂长约10cm。供区创面直接拉拢缝合。结果 :14例皮瓣成活,1例因术后第2天发生动脉血管危象,抢救皮瓣无效,皮瓣坏死。术后随访12个月以上,所有患者均无肿瘤复发,肘部瘢痕较细,肘运动无障碍,未出现桡神经损伤引起的垂腕,2例患者供区局部有麻木感,6个月后症状减轻。术后患者语言功能恢复良好,鼻咽纤维镜检查吞咽顺利,腭咽闭合良好。所有患者likert评分法均为4~5分。结论:游离延展上臂外侧皮瓣解剖恒定、厚度适宜、血供可靠,是修复口腔癌术后软组织缺损的一种较好的选择。
Objective: To investigate the clinical effect of free extended upper lateral arm flap in repairing postoperative soft tissue defect of oral cancer. METHODS: From January 2011 to December 2013, a total of 15 cases of soft tissue defect caused by oral cancer were treated by free extension of the lateral flap of the upper arm. One week before operation, Doppler flow detector was used to measure the radial artery After mutation, the flaps and flaps were surgically placed over the lateral epicondyle of the humerus according to their movement and area of soft tissue defects. The area was 4 cm × 5 cm to 11 cm × 5 cm and the length of the vascular pedicle was about 10 cm. Wound for the area directly wound suture. Results: Fourteen flaps survived. One case developed arterial crisis on the second postoperative day, the flap was invalid and the flap was necrosis. All the patients were followed up for more than 12 months. All the patients had no tumor recurrence, thin elbow scar, no movement of the elbow, no hanging wrist caused by radial nerve injury, 2 patients with numbness in the area, and 6 months later Symptoms are relieved. Postoperative language function recovered well, nasopharyngeal fiberoscopy swallowing smoothly, velopharyngeal closure is good. All patients with likert score were 4 to 5 points. CONCLUSION: The free-extending upper lateral arm flap has a constant anatomy, suitable thickness and reliable blood supply. It is a better choice for repair of postoperative soft tissue defects in oral cancer.