Song Xiao-Meng, Ye Jin-Hai, Yuan Ye, Zhang Shuang-Yue, Jiang Hong-Bing, Wu Yu-Nong
Institute of Stomatology, Department of Oral and Maxillofacial Surgery, Nanjing Medical University, Nanjing, China.
ORL J Otorhinolaryngol Relat Spec. 2010;72(2):106-12. doi: 10.1159/000301155. Epub 2010 May 5.
A modified radial forearm free flap was designed to rehabilitate function and to reduce the complications at both donor and recipient sites.
Between 2003 and 2007, 15 patients with infiltrating squamous cell carcinoma (T(3)-T(4)) of the tongue and/or floor of the mouth underwent hemiglossectomy and resection of the floor of the mouth with microvascular reconstruction using a modified radial forearm flap. The mean size of the forearm flap was 7.5 x 14 cm, and the de-epithelialized area was 7 x 6 cm, requiring no skin graft from the abdomen. Speech intelligibility tests were administered to test postoperative speech and the functional oral intake scale was applied to assess the postoperative swallowing function, and patients reconstructed with pectoralis major myocutaneous flap were used for comparison.
All the flaps were successfully transferred. No obvious complications were found in either the oral-maxillofacial or forearm region. The speech intelligibility was better in the modified flap group (p < 0.01). An acceptable swallowing function was also achieved, although the difference was not significant (p > 0.05).
The modified flap used for reconstructing large defects of the tongue and floor of the mouth might be a valid substitute for pectoralis major myocutaneous flap to improve the outcome in individuals with significant oral carcinoma.
设计一种改良的桡侧前臂游离皮瓣以恢复功能并减少供区和受区的并发症。
2003年至2007年期间，15例舌和/或口底浸润性鳞状细胞癌（T(3)-T(4)）患者接受了半舌切除术和口底切除术，并使用改良的桡侧前臂皮瓣进行微血管重建。前臂皮瓣的平均大小为7.5×14 cm，去上皮面积为7×6 cm，无需取自腹部的皮肤移植。进行语音清晰度测试以检测术后语音，并应用功能性口腔摄入量表评估术后吞咽功能，并用胸大肌肌皮瓣重建的患者进行比较。
所有皮瓣均成功转移。口腔颌面区域或前臂区域均未发现明显并发症。改良皮瓣组的语音清晰度更好（p < 0.01）。虽然差异不显著（p > 0.05），但也实现了可接受的吞咽功能。
用于重建舌和口底大缺损的改良皮瓣可能是胸大肌肌皮瓣的有效替代物，以改善患有严重口腔癌患者的治疗效果。
