Urken M L, Weinberg H, Vickery C, Aviv J E, Buchbinder D, Lawson W, Biller H F
Department of Otolaryngology Mount Sinai Medical Center, New York, NY 10029.
Laryngoscope. 1992 May;102(5):543-58. doi: 10.1288/00005537-199205000-00014.
The loss of motor and sensory function of the tongue following ablative surgery has a devastating effect on oral function. At the present time, there is no way to restore lost tongue musculature following partial glossectomy. The use of sensate cutaneous flaps has been shown to restore sensory feedback to reconstructed areas of the oral cavity. No single composite flap supplies a sensate soft-tissue component together with an osseous component of sufficient bone stock for functional mastication. In this article, the combination of the radial forearm free flap with the iliac crest osteocutaneous or osteomyocutaneous free flap is reported. The radial forearm free flap was used to resurface the resected portion of the tongue to provide maximum mobility and sensation. The lingual nerve was the recipient nerve for anastomosis to the antebrachial cutaneous nerves in all but one case. The iliac bone was used to reconstruct the mandible, with the iliac skin paddle or the internal oblique muscle used to reconstruct the neoridge. This combination of flaps was used in 10 patients. There was one flap failure due to vascular kinking from "piggybacking" the iliac crest to the distal end of the radial forearm flap. As a result, the use of two separate sets of recipient vessels is now advocated. Although a single composite free flap offers an excellent form of oromandibular reconstruction in most cases, it has been shown that oral function deteriorates when large areas of anesthesia are present in the oral cavity. We believe that this combination of two free flaps offers an opportunity for superior function in select patients with significant glossectomy and/or large mucosal defects.
切除术后舌头运动和感觉功能的丧失对口腔功能有毁灭性影响。目前，部分舌切除术后无法恢复丧失的舌肌组织。已证明使用带感觉的皮瓣可恢复口腔重建区域的感觉反馈。没有单一的复合皮瓣能同时提供带感觉的软组织成分和足够骨量用于功能性咀嚼的骨性成分。本文报道了桡侧前臂游离皮瓣与髂嵴骨皮瓣或骨肌皮瓣的联合应用。桡侧前臂游离皮瓣用于覆盖舌的切除部分，以提供最大的活动度和感觉。除1例患者外，舌神经均作为受区神经与前臂皮神经进行吻合。髂骨用于重建下颌骨，髂部皮瓣或内斜肌用于重建新的牙槽嵴。10例患者采用了这种联合皮瓣。有1例皮瓣失败，原因是将髂嵴“搭”在桡侧前臂皮瓣远端导致血管扭曲。因此，现在主张使用两组独立的受区血管。尽管在大多数情况下，单一的复合游离皮瓣是口腔颌面部重建的一种极好方式，但已表明当口腔内存在大面积麻醉区域时，口腔功能会恶化。我们认为，对于有明显舌切除和/或大面积黏膜缺损的特定患者，这种联合两种游离皮瓣的方法提供了获得更好功能的机会。
