Liu Jinbing, Wu Hanjiang, Zhu Zhaofu, Wu Xiangqing, Tan Hongyu, Wang Kai
Department of Oral and Maxillofacial Surgery, the Second Xiangya Hospital of Central South University, Changsha Hunan, 410011, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Jan;24(1):82-6.
To evaluate the results of the reconstruction of the soft tissue defects following the en block resection of tongue cancer using free anterolateral thigh myocutaneous flaps.
From November 2006 to December 2008, 109 cases underwent the reconstruction of the soft tissue defects following the en block resection of tongue cancer using free anterolateral thigh myocutaneous flaps. There were 75 males and 34 females with an age of 23-75 years (50.4 years on average). The disease course was 1-6 months. According to 2002 International Union Control Cancer (IUCC) criterion for TNM stage, there were 35 cases of T2N0M0, 8 cases of T2N1M0, 2 cases of T2N2M0, 31 cases of T3N0M0, 12 cases of T3N1M0, 7 cases of T3N2M0, 5 cases of T4N0M0, 4 cases of T4N1M0, 3 cases of T4N2M0, and 2 cases of T4N3M0. The range of tongue defect was 5 cm x 3 cm to 12 cm x 8 cm. The flap area ranged from 7 cm x 4 cm to 20 cm x 8 cm. Eighty-two patients with T3, T4 and positive lymph node metastasis determined by pathological examination after operation received radiotherapy. The vitality of the flaps and the healing of the wounds were observed postoperatively. The shape and function of the reconstructed tongue were determined, the influences on function at donor site were evaluated and the flap tolerance to radiotherapy was investigated during the follow-up period.
Mouth floor mandibular fistula occurred in 5 cases 5-7 days after operation, seroma formation in 1 case and wound dehiscence in another case at the donor site; the wounds healed by secondary intention after dressing. The other wounds healed primarily. All 105 flaps survived completely, 3 flaps developed partial necrosis 3-5 days after operation, the wounds healed after dressing; and 1 flap failed 3 days after operation, then it was removed and defects was repaired using pectoralis major muscle flap. Blisters occurred in 8 flaps (all being thinning flaps) 1 day after operation. The overall complete survival of the flap was 96.3% (105/109). The patients were followed up for 0.5-2.5 years (1.2 years on average). Although the flaps had a little atrophy, the shape of the reconstructed tongue was still satisfactory with suitable tongue-mandibular groove. No depression was observed in the mandibular region. The speech as well as swallowing function were well recovered. The scar was easily hidden with no important functional impairment at the donor site. No flap necrosis occurred in all the patients who received postoperative radiotherapy.
Free anterolateral thigh myocutaneous flap transplantation is safe and reliable, and it has the advantages of the better result at the recipient site, the less morbidity at the donor site, fewer postoperative complications and excellent tolerance to radiotherapy. So it is an ideal flap to repair soft tissue defects following the en block resection of tongue cancer.
评估采用游离股前外侧肌皮瓣修复舌癌整块切除术后软组织缺损的效果。
2006年11月至2008年12月，109例患者采用游离股前外侧肌皮瓣修复舌癌整块切除术后软组织缺损。其中男性75例，女性34例，年龄23 - 75岁（平均50.4岁）。病程1 - 6个月。根据2002年国际抗癌联盟（IUCC）TNM分期标准，T2N0M0 35例，T2N1M0 8例，T2N2M0 2例，T3N0M0 31例，T3N1M0 12例，T3N2M0 7例，T4N0M0 5例，T4N1M0 4例，T4N2M0 3例，T4N3M0 2例。舌缺损范围为5 cm×3 cm至12 cm×8 cm。皮瓣面积为7 cm×4 cm至20 cm×8 cm。82例术后病理检查提示T3、T4及有阳性淋巴结转移患者接受放疗。术后观察皮瓣存活情况及伤口愈合情况。随访期间测定重建舌的外形及功能，评估供区功能影响，观察皮瓣对放疗的耐受性。
术后5 - 7天，5例出现口底下颌瘘，供区1例形成血清肿，另1例伤口裂开；经换药后伤口二期愈合。其余伤口一期愈合。105块皮瓣全部完全存活，3块皮瓣术后3 - 5天出现部分坏死，经换药后伤口愈合；1块皮瓣术后3天失败，予以切除后采用胸大肌肌皮瓣修复缺损。8块皮瓣（均为薄型皮瓣）术后1天出现水疱。皮瓣总体完全成活率为96.3%（105/109）。患者随访0.5 - 2.5年（平均1.2年）。虽皮瓣稍有萎缩，但重建舌外形仍满意，舌下颌沟合适。下颌区无凹陷。语音及吞咽功能恢复良好。供区瘢痕易隐蔽，无重要功能障碍。所有接受术后放疗患者未出现皮瓣坏死。
游离股前外侧肌皮瓣移植安全可靠，具有受区效果好、供区并发症少、术后并发症少及对放疗耐受性好等优点。是修复舌癌整块切除术后软组织缺损的理想皮瓣。
