Lin Yi, Zhu Huiyong, Liu Jianhua, Wang Huiming
Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310006, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Apr;24(4):452-4.
To investigate clinical effect and prognosis of the modified sternocleidomastoid (MSCM) myocutaneous flap for reconstruction of tissue defects in patients with oral carcinomas undergoing tumorectomy.
From April 2001 to January 2007, 43 patients with large or medium-sized tissue defects because of oral carcinomas radical operation were treated with MSCM myocutaneous flap. There were 31 males and 12 females with an average age of 58.5 years (25-76 years). The disease course was 25 days to 14 months (4.5 months on average). There were 27 cases of well-differentiated squamous cell carcinoma (SC), 14 cases of poorly-differentiated SC, 1 case of rhabdomyosarcoma, and 1 case of adenoid cystic carcinoma. Affected locations were tongue in 25 cases, mouth floor in 11 cases, lower gingiva in 4 cases, and buccal mucous membranes in 3 cases. According to 2002 International Union Control Cancer criterion for clinical stage, there were 3 cases of stage I, 13 cases of stage II, 7 cases of stage III, and 20 cases of stage IV. Both the ranges of soft tissue defects and the flap were from 4 cm x 3 cm to 8 cm x 6 cm. The vitality of the flaps and the healing of wounds were observed postoperatively. The function restoration of deglutition and dehisce were observed during the follow-up period.
Necrosis of quarter MSCM myocutaneous flap occurred in 3 cases 1 week after operation, wounds healed by secondary intention after dressing; other flaps were survival. Infection with fluidity occurred at the donor site of 2 cases, wounds healed by incision and drainage; other incision at the donor sites healed primarily. No arterial or venous crisis occurred in all 43 flaps after 48 hours of operation. Thirty-nine patients were followed up for 6 months to 6 years. The 3 patients with buccal carcinoma could open their mouths normally. The function of deglutition and pronunciation were recovered in 24 patients with tongue carcinoma. Only 3 patients needed to have soft diet after operation. In 26 patients who were followed up above 2 years, oral metaplasia of the the skin flaps epithelium was observed. Four patients and 2 patients recurred and died after 6 months and 1 year of operation, respectively. Two patients received the second operation after 6 months because of the metastatic lymph node, and survived up to now. The 2-year survival rate was 85%.
MSCM myocutaneous flap is simple to perform and effective in reconstruction of tissue defects for patients with oral carcinomas. It has active effect to recover the function of oral and maxillofacial region and elevate living quality of patients.
探讨改良胸锁乳突肌（MSCM）肌皮瓣修复口腔癌根治术后组织缺损的临床效果及预后。
2001年4月至2007年1月，对43例因口腔癌根治术导致大中型组织缺损的患者采用MSCM肌皮瓣修复。其中男性31例，女性12例，平均年龄58.5岁（25 - 76岁）。病程25天至14个月（平均4.5个月）。高分化鳞状细胞癌（SC）27例，低分化SC 14例，横纹肌肉瘤1例，腺样囊性癌1例。病变部位：舌部25例，口底11例，下牙龈4例，颊黏膜3例。按照2002年国际抗癌联盟临床分期标准，Ⅰ期3例，Ⅱ期13例，Ⅲ期7例，Ⅳ期20例。软组织缺损范围及皮瓣大小均为4 cm×3 cm至8 cm×6 cm。术后观察皮瓣活力及伤口愈合情况，随访期间观察吞咽及张口功能恢复情况。
术后1周3例出现MSCM肌皮瓣1/4坏死，经换药后伤口二期愈合；其余皮瓣均存活。供区2例发生液化感染，经切开引流后伤口愈合；其余供区切口一期愈合。43例皮瓣术后48小时均未发生动静脉危象。39例患者随访6个月至6年。3例颊癌患者术后张口正常。24例舌癌患者吞咽及发音功能恢复。术后仅3例需进软食。26例随访2年以上患者皮瓣上皮出现口腔化生。4例和2例患者分别于术后6个月和1年复发死亡。2例患者术后6个月因颈部淋巴结转移行二次手术，至今存活。2年生存率为85%。
MSCM肌皮瓣修复口腔癌组织缺损操作简便、效果良好，对恢复口腔颌面部功能、提高患者生活质量有积极作用。
