Yoleri L, Mavioğlu H
Department of Plastic and Reconstructive Surgery, Celal Bayar University Medical School, Manisa, Turkey.
Ann Plast Surg. 2000 Aug;45(2):181-6. doi: 10.1097/00000637-200045020-00016.
The tongue is one of the most difficult structures of the body to reconstruct if more than 85% to 90% of it has been resected. A functional neotongue requires both soft-tissue bulk and restoration of muscle function. The innervated gracilis muscle flap folded on itself was used to reconstruct a total glossectomy defect. The genioglossus muscle, which makes the greatest contribution to swallowing, and the mylohyoid muscle, which elevates the larynx to prevent aspiration, were simulated with the design and placement of the gracilis muscle. The muscle was placed and secured longitudinally from the remnant of the tongue base and pharynx to the mandible, and then folded on itself and attached to the hyoid bone. The obturator nerve to the gracilis was coapted with the hypoglossal nerve. The patient was able to resume oral feeding without aspiration. Electromyographic results demonstrated reinnervation of the flap with active elevation of the mouth base. The patient died 1 year postoperatively because of recurrence of her disease. This type of design and placement of gracilis muscle transplantation is recommended.
如果舌头超过85%至90%被切除，那么它是人体最难重建的结构之一。功能性新舌既需要软组织量，也需要肌肉功能的恢复。将带神经的股薄肌瓣自身折叠用于重建全舌切除术缺损。通过股薄肌的设计和放置模拟了对吞咽贡献最大的颏舌肌以及抬高喉部以防止误吸的下颌舌骨肌。将该肌肉从舌根和咽部残端纵向放置并固定到下颌骨，然后自身折叠并附着到舌骨。股薄肌的闭孔神经与舌下神经吻合。患者能够恢复经口进食且无误吸。肌电图结果显示皮瓣重新获得神经支配，口底有主动抬高。患者术后1年因疾病复发死亡。推荐这种股薄肌移植的设计和放置方式。
