Wei Dong, Liu Jian-hua, Zhao Wen-quan, Zhu Hui-yong, Li Zhi-yong, Wang Hui-ming
Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province 310003, PR China.
Br J Oral Maxillofac Surg. 2013 Dec;51(8):742-6. doi: 10.1016/j.bjoms.2013.02.015. Epub 2013 May 20.
Our aim was to evaluate the reliability of sternocleidomastoid (SCM) flaps in the reconstruction of defects after oral and maxillofacial resections, and summarise the ways in which morbidity can be reduced. We retrospectively enrolled 65 patients who had malignant tumours resected, and assessed the postoperative viability of the SCM flap. All complications were recorded during a follow up period of 1-64 months. We also investigated the relation between recurrence in regional lymph nodes and their preoperative histological state. The conventional SCM flap, the split SCM flap with only the sternal head, and the SCM flap with a half-thickness clavicular graft, were used to repair different defects. No flaps necrosed completely, and in only 5 cases was there partial loss of the skin paddle. The skin paddle avulsed in 2 cases 2 patients developed wound infections. Only 9 patients developed complications (14%, 9/65). Use of the split SCM flap overcomes the problem of bulk. The combination of the SCM flap and clavicular bone enables early dental implantation. The SCM flap is convenient, reliable, and technically easy for the reconstruction of intraoral or mandibular tissue loss. Preservation of the branch of the superior thyroid artery and precise surgical technique contribute to a higher success rate.
我们的目的是评估胸锁乳突肌（SCM）皮瓣在口腔颌面切除术后缺损重建中的可靠性，并总结降低其并发症发生率的方法。我们回顾性纳入了65例接受恶性肿瘤切除的患者，评估了SCM皮瓣术后的存活情况。在1至64个月的随访期内记录了所有并发症。我们还研究了区域淋巴结复发与其术前组织学状态之间的关系。采用传统的SCM皮瓣、仅保留胸骨头的劈开SCM皮瓣以及带半厚锁骨移植的SCM皮瓣修复不同的缺损。没有皮瓣完全坏死，仅5例出现皮瓣部分坏死。2例皮瓣撕脱，2例患者发生伤口感染。仅9例患者出现并发症（14%，9/65）。使用劈开SCM皮瓣可解决体积过大的问题。SCM皮瓣与锁骨骨联合使用可实现早期牙种植。SCM皮瓣用于重建口腔内或下颌组织缺损方便、可靠且技术操作简单。保留甲状腺上动脉分支和精确的手术技术有助于提高成功率。
