Ozkan Ozlenen, Ozkan Omer, Derin Alper Tunga, Bektas Gamze, Cinpolat An, Duymaz Ahmet, Mardini Samir, Cigna Emanuele, Chen Hung-Chi
From the Departments of *Plastic, Reconstructive and Aesthetic Surgery, †Otorhinolaryngology, Akdeniz University School of Medicine, Antalya; and ‡Department of Plastic, Reconstructive and Aesthetic Surgery, Tatvan State Hospital, Bitlis, Turkey.
Ann Plast Surg. 2015 May;74(5):557-64. doi: 10.1097/SAP.0b013e3182a6add7.
The purpose of this study was to report the motor functional outcomes and sensory recovery of patients who had undergone total or subtotal glossectomy for oral squamous cell carcinomas reconstructed with chimeric anterolateral thigh (ALT) flaps.
Six patients, 4 men and 2 women, with a mean age of 49.5 years (range, 36-73 years) were included in the study. All patients were treated with chimeric ALT, including the vastus lateralis muscle with its motor nerve and skin paddle with its innervating nerve. All patients were administered functional tests involving sensory recovery, intelligibility, and swallowing. Flap sensibility was evaluated using light touch sensation with the Semmes-Weinstein monofilament test, 2-point discrimination according to the Weber sensitive test, warm and cold temperature sensations, and pain sensation. Intelligibility was scored by a speech therapist on a scale from 1 to 5. Swallowing was assessed by electromyography, deglutition scores (on a scale of 1 to 8), and modified barium swallow. Donor-site morbidities were recorded.
Mean follow-up was 26.6 months (6 months-5 years). The flaps were successful in all 6 patients. The donor site was closed primarily and no complications were seen in the follow-up period. Normal extension of the knee joint and no evidence of lateral patella instability occurred. Speech intelligibility was good (4) in 3 patients and acceptable (3) in 3. Deglutition scores were 6 in 2 patients, 5 in 2, and 4 in 2. Modified barium swallow revealed that 4 patients experienced bolus transit, but 2 required a liquid swallow to promote bolus transit. Electromyographic recordings showed innervations of the vastus lateralis muscle with active generation of motor unit potentials in 4 patients when trying to elevate the tongue. This was not performed in 1 patient, and 1 other had macroscopic muscle contractions. All sensory tests were satisfactory in all parameters.
The results of this reconstructive option were satisfactory in terms of motor function and sensitive assessment of the neotongue. This technique is strongly recommended for patients with total or subtotal glossectomy.
本研究的目的是报告接受全舌切除术或次全舌切除术治疗口腔鳞状细胞癌并采用嵌合股前外侧（ALT）皮瓣重建的患者的运动功能结果和感觉恢复情况。
本研究纳入了6例患者，其中4例男性，2例女性，平均年龄49.5岁（范围36 - 73岁）。所有患者均接受了包含股外侧肌及其运动神经以及带神经支配的皮瓣的嵌合ALT皮瓣治疗。所有患者均接受了涉及感觉恢复、可懂度和吞咽的功能测试。使用Semmes-Weinstein单丝试验通过轻触觉评估皮瓣感觉，根据Weber敏感试验评估两点辨别力，评估冷热温度觉和痛觉。可懂度由言语治疗师按1至5分进行评分。通过肌电图、吞咽评分（1至8分）和改良吞钡检查评估吞咽情况。记录供区并发症。
平均随访26.6个月（6个月至5年）。所有6例患者的皮瓣均成功。供区一期缝合，随访期间未出现并发症。膝关节伸展正常，未发现髌骨外侧不稳定的证据。3例患者的言语可懂度良好（4分），3例患者的言语可懂度可接受（3分）。吞咽评分方面，2例患者为6分，2例患者为5分，2例患者为4分。改良吞钡检查显示4例患者出现食团通过，但2例患者需要液体吞咽以促进食团通过。肌电图记录显示，4例患者在试图抬高舌头时股外侧肌有神经支配且有运动单位电位的活跃产生。1例患者未进行此项检查，另1例患者有肉眼可见的肌肉收缩。所有感觉测试的所有参数均令人满意。
就新舌的运动功能和感觉评估而言，这种重建方法的结果令人满意。强烈推荐将此技术用于接受全舌切除术或次全舌切除术的患者。
