López-Arcas Jose María, Arias Javier, Morán María José, Navarro Ignacio, Pingarrón Lorena, Chamorro Manuel, Burgueño Miguel
Oral and Maxillofacial Surgery Department, Hospital Sanitas La Moraleja, Madrid, Spain.
J Oral Maxillofac Surg. 2012 Mar;70(3):740-7. doi: 10.1016/j.joms.2011.02.098. Epub 2011 Jul 29.
Total or subtotal glossectomy following the resection of intraoral tumors causes significant morbidity. However, which reconstructive technique is the most successful remains controversial.
After approval by the Ethics Committee, charts were reviewed retrospectively for patients treated at the Oral and Maxillofacial Surgery Department, University Hospital La Paz (Madrid, Spain), during a 3-year period (2005-2008). All were reconstructed with a deep inferior epigastric artery perforator (DIEAP) flap after total glossectomy. Data collected included affiliation data, extent of extirpation, type of reconstruction, and surgical outcome, including donor-site morbidity, complications, and functional results.
Seven patients (5 men, 71.4%; 2 women, 28.6%) with primary squamous cell carcinoma of the tongue underwent total glossectomy and simultaneous microsurgical reconstruction with a DIEAP flap. In all cases, the flap was harvested with a fusiform shape oriented craniocaudally and limited to zone 1. The average size of the flap was 16.7 × 7.2 cm. Functional outcome related to swallowing was poor; 57.1% of the patients required a permanent gastrostomy. Speech was considered intelligible in 85.7% of cases by 2 independent observers. The surgical outcome was uneventful in most of the cases, with only 1 case of local dehiscence at the mouth floor. None of the cases developed abdominal wall dehiscence or an abdominal hernia at mid- or long-term follow-up.
The DIEAP flap is a reliable alternative for tongue reconstruction. It provides a large volume of soft tissue for transfer and is predictable and stable over time with low donor-site morbidity.
口腔肿瘤切除术后行全舌切除术或次全舌切除术会导致严重的并发症。然而，哪种重建技术最为成功仍存在争议。
经伦理委员会批准后，对西班牙马德里拉巴斯大学医院口腔颌面外科在3年期间（2005 - 2008年）治疗的患者病历进行回顾性分析。所有患者在全舌切除术后均采用腹壁下动脉穿支（DIEAP）皮瓣进行重建。收集的数据包括患者相关资料、切除范围、重建类型以及手术结果，包括供区并发症、其他并发症和功能结果。
7例（5例男性，占71.4%；2例女性，占28.6%）原发性舌鳞状细胞癌患者接受了全舌切除术并同时采用DIEAP皮瓣进行显微外科重建。在所有病例中，皮瓣均采用头足向的梭形切取，且局限于1区。皮瓣平均大小为16.7×7.2厘米。与吞咽相关的功能结果较差；57.1%的患者需要永久性胃造口术。两名独立观察者认为85.7%的病例语音清晰可懂。大多数病例手术结果顺利，仅1例口底局部裂开。在中长期随访中，无一例发生腹壁裂开或腹壁疝。
DIEAP皮瓣是舌重建的可靠选择。它能提供大量可转移的软组织，随着时间推移可预测且稳定，供区并发症发生率低。
