Agostini T, Agostini V
Department of Plastic, Reconstructive and Aesthetic Surgery, University of Florence, Faculty of Medicine and Surgery, Largo Palagi 1, 50134 Florence, Italy.
J Plast Reconstr Aesthet Surg. 2008 Oct;61(10):1164-9. doi: 10.1016/j.bjps.2008.03.038. Epub 2008 Aug 8.
The restoration of the buccal mucosa is the main challenge for the plastic surgeon. In the past 15 years the free radial forearm flap has been widely used, due to its thickness and pliability. More recently, the anterolateral thigh free flap has become the customary flap in oral cavity reconstruction.
Six patients affected by oral cavity tumours underwent microsurgical reconstruction with the adipofascial anterolateral thigh free flap between December 2005 and December 2006.
One flap was lost due to venous thrombosis. In the other five flaps the postoperative period was uneventful. The patients are still free from disease. Multiple biopsies were performed to compare the neo-mucosa with the native. No relevant differences have emerged.
Replacing tissue with like tissue should be the surgeon's aim. In the authors' opinion, the adipofascial variation of the anterolateral thigh free flap is the ideal replacement for oral cavity mucosa, allowing good fixation and mobility, and optimum aesthetic and functional results. It can be thinned to fit the defect with low risk. The patching condition resulting from fasciocutaneous flaps reconstruction is avoided. The remucosalisation of the flap occurs in about 1 month for the neo-mucosal functions as it does in the native tissue. It is non-hair bearing and is not influenced by postoperative radiotherapy.
颊黏膜的修复是整形外科医生面临的主要挑战。在过去15年中，由于其厚度和柔韧性，游离桡侧前臂皮瓣得到了广泛应用。最近，股前外侧游离皮瓣已成为口腔重建中的常用皮瓣。
2005年12月至2006年12月期间，6例口腔肿瘤患者接受了股前外侧脂肪筋膜游离皮瓣显微外科重建手术。
1例皮瓣因静脉血栓形成而坏死。其他5例皮瓣术后恢复顺利。患者仍无疾病复发。进行了多次活检以比较新黏膜与原生黏膜。未发现明显差异。
用相似组织替代组织应是外科医生的目标。作者认为，股前外侧游离皮瓣的脂肪筋膜变异型是口腔黏膜的理想替代物，具有良好的固定性和活动性，以及最佳的美学和功能效果。它可以变薄以适应缺损，风险较低。避免了筋膜皮瓣重建导致的修补情况。皮瓣的重新黏膜化在大约1个月内发生，因为新黏膜的功能与原生组织相同。它不长毛发，不受术后放疗的影响。
