Ma Chunyue, Tian Zhuowei, Kalfarentzos Evagelos, He Yue
Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
Clinical Fellow, Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
J Oral Maxillofac Surg. 2015 Aug;73(8):1641-50. doi: 10.1016/j.joms.2014.12.022. Epub 2015 Jan 6.
Surgical reconstruction of extensive retromolar and lateral buccal defects after oncologic resection remains a major challenge because early and aggressive invasion by retromolar malignancies generally entails wider resection of several local anatomic structures to attain tumor-free margins. The superficial circumflex iliac artery perforator (SCIP) flap, which is a promising candidate with multiple advantages, provides a better choice of quality and esthetics for such reconstruction.
Three patients (median age, 44.7 yr; age range, 23 to 63 yr) diagnosed with retromolar or lateral buccal squamous cell carcinoma (or mucoepidermoid carcinoma) underwent ablative surgery and simultaneous SCIP flap reconstruction. Preoperative computed tomographic angiographic (CTA) and color ultrasonographic images were used for confirmation and positioning of the SCIPs. Volumes of defects and corresponding SCIP flaps were recorded and analyzed. In addition, pre- and postoperative functions of speech, swallowing, and mouth opening and donor-site morbidity were compared.
The SCIP flaps were raised according to information gathered from CTA and sonographic imaging. The median pedicle length reached 8.2 cm and the flap sizes ranged from 5 × 6 to 6.0 × 8.0 cm. All flaps survived uneventfully during the perioperative period and subsequent follow-up showed no recurrence. Compatible donor-recipient volume, easy harvesting, acceptable postoperative functions, and inconspicuous donor-site scars were regarded as the main advantages of the SCIP flaps.
For defects after resection of retromolar and lateral buccal tumors, the SCIP flap might play an innovative and supplementary role to traditional soft tissue reconstruction approaches.
肿瘤切除术后广泛的磨牙后区和颊侧缺损的外科重建仍然是一项重大挑战，因为磨牙后区恶性肿瘤的早期侵袭性生长通常需要更广泛地切除多个局部解剖结构以获得无瘤切缘。旋髂浅动脉穿支（SCIP）皮瓣具有多种优势，是一种很有前景的选择，为这种重建提供了更好的质量和美学效果。
3例患者（中位年龄44.7岁；年龄范围23至63岁）被诊断为磨牙后区或颊侧鳞状细胞癌（或黏液表皮样癌），接受了根治性手术并同时进行了SCIP皮瓣重建。术前计算机断层血管造影（CTA）和彩色超声图像用于确认和定位SCIP。记录并分析缺损体积和相应的SCIP皮瓣。此外，比较了术前和术后的言语、吞咽、张口功能以及供区并发症。
根据CTA和超声成像收集的信息掀起SCIP皮瓣。中位蒂长达到8.2 cm，皮瓣大小范围为5×6至6.0×8.0 cm。所有皮瓣在围手术期均顺利存活，随后的随访未显示复发。供受区体积匹配、易于切取、术后功能可接受以及供区瘢痕不明显被认为是SCIP皮瓣的主要优点。
对于磨牙后区和颊侧肿瘤切除后的缺损，SCIP皮瓣可能对传统软组织重建方法起到创新和补充作用。
