Song Ming, Chen Fu-Jin, Guo Zhu-Ming, Zhang Quan, Yang An-Kui
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P.R. China.
Ai Zheng. 2009 Jun;28(6):663-7.
Reconstructing buccal defects with proper flaps can expand the indications of surgery, improve quality of life and prolong survival. This study was to investigate the indications for such application, the selection of different kinds of flaps and the skills of the reconstructive operation.
From September 2005 to August 2007, 26 patients underwent reconstructive operation after resection of buccal mucosa carcinoma: eight had simple buccal mucosa resection, 11 had resection of the bucca cavioris and facial skin, seven had resection of the bucca cavioris, facial skin and angulus oris; besides, seven patients underwent parotid duct resection. As for the reconstructive operation, pectoralis major myocutaneous flap was used in five patients, free radial forearm flap in 11 patients, free anterolateral thigh flap in six patients, and sternodeiceomastoid myocutaneous flap in four patients. Eight patients received postoperative radiotherapy at 66-70 Gy.
No perioperative death occurred. Necrosis happened in one patient who used free radial forearm flap; partial necrosis in one patient who used pectoralis major myocutaneous flap. The survival rate of the flaps was 96.2%. Hydrops of the operative wound happened in one patient with salivary fistula. During the follow-up of 1-3 years, seven patients had recurrence (four had recurrence in primary lesion and three in cervical lymph nodes), two died of recurrence in primary lesion.
The free anterolateral thigh flap and free radial forearm flap are suitable for reconstruction of large buccal defects, and are first-choices for defects larger than 4 cm; the pectoralis major myocutaneous flap can be applied as the second-choice flap; the sternodeiceomastoid myocutaneous flap can be used for defects smaller than 4 cm.
采用合适的皮瓣修复颊部缺损可扩大手术适应证，提高生活质量，延长生存期。本研究旨在探讨此类应用的适应证、不同皮瓣的选择及修复手术技巧。
2005年9月至2007年8月，26例颊黏膜癌切除术后患者接受修复手术：8例行单纯颊黏膜切除，11例行颊腔及面部皮肤切除，7例行颊腔、面部皮肤及口角切除；此外，7例患者行腮腺导管切除。修复手术中，5例采用胸大肌肌皮瓣，11例采用游离桡侧前臂皮瓣，6例采用游离股前外侧皮瓣，4例采用胸锁乳突肌肌皮瓣。8例患者术后接受66 - 70 Gy放疗。
围手术期无死亡发生。1例采用游离桡侧前臂皮瓣的患者发生坏死；1例采用胸大肌肌皮瓣的患者发生部分坏死。皮瓣成活率为96.2%。1例患者手术伤口出现积液伴涎瘘。随访1 - 3年，7例复发（4例原发灶复发，3例颈部淋巴结复发），2例因原发灶复发死亡。
游离股前外侧皮瓣和游离桡侧前臂皮瓣适用于大面积颊部缺损修复，是4 cm以上缺损的首选；胸大肌肌皮瓣可作为次选皮瓣；胸锁乳突肌肌皮瓣可用于4 cm以下缺损。
