Chow Tam-Lin, Chan Tony Tung-Fei, Chow Tak-Kun, Fung Siu-Chung, Lam Siu-Ho
Hong Kong, S.A.R. From the Divisions of Head and Neck Surgery, Breast Surgery, Reconstructive Surgery, and Maxillofacial and Dental Surgery, United Christian Hospital.
Plast Reconstr Surg. 2007 Aug;120(2):431-436. doi: 10.1097/01.prs.0000267343.10982.dc.
The submental flap was described for head and neck reconstruction more than a decade ago. Its application is confined mainly to nonmalignant diseases or low-grade malignancies, as the submental flap resides in the level I lymphatic drainage region of the neck. The authors report the use of the submental flap for soft-tissue reconstruction in a selected group of patients with aggressive orofacial cancer.
From March of 2003 to September of 2005, 10 patients (nine with intraoral squamous cell carcinoma and one with facial angiosarcoma) underwent submental flap reconstruction after surgical extirpation of aggressive orofacial malignancies. The indications were severe comorbidity, old age, the presence of another incurable cancer, and/or the patient's skepticism about undergoing a free flap operation.
Of the surviving patients, the median follow-up was 21 months (range, 2 to 37 months). There were no cases of total flap failure, but partial necrosis occurred in two cases. Three patients experienced tumor recurrence, but only one case might have been related to use of the submental flap. Postoperative oral function, in terms of swallowing and speech, was well preserved; conventional dentures were fabricated for four patients.
In selected patients with aggressive orofacial cancer, the submental flap is an expedient alternative to free tissue transfer for reconstruction. Nonetheless, indiscriminate use might compromise the oncological outcome, so it cannot be regarded as a standard method of treatment.
十多年前就有关于颏下皮瓣用于头颈部重建的描述。由于颏下皮瓣位于颈部I级淋巴引流区域，其应用主要局限于非恶性疾病或低级别恶性肿瘤。作者报告了在一组侵袭性口腔颌面癌患者中使用颏下皮瓣进行软组织重建的情况。
2003年3月至2005年9月，10例患者（9例口腔鳞状细胞癌，1例面部血管肉瘤）在手术切除侵袭性口腔颌面恶性肿瘤后接受了颏下皮瓣重建。适应症包括严重的合并症、老年、存在另一种无法治愈的癌症和/或患者对进行游离皮瓣手术持怀疑态度。
在存活的患者中，中位随访时间为21个月（范围为2至37个月）。没有皮瓣完全坏死的病例，但有2例发生部分坏死。3例患者出现肿瘤复发，但只有1例可能与使用颏下皮瓣有关。术后吞咽和言语方面的口腔功能得到了很好的保留；为4例患者制作了传统假牙。
在选定的侵袭性口腔颌面癌患者中，颏下皮瓣是游离组织移植重建的一种便捷替代方法。尽管如此，不加选择地使用可能会影响肿瘤治疗效果，因此不能将其视为标准的治疗方法。
