Oral & Maxillofacial-Head & Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Guangzhou 510120, China; Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation of Sun Yat-Sen Memorial Hospital, Guangzhou 510120, China.
Oral & Maxillofacial-Head & Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Guangzhou 510120, China.
Oral Oncol. 2019 Feb;89:1-7. doi: 10.1016/j.oraloncology.2018.12.004. Epub 2018 Dec 13.
A no-flap design based on actual tongue anatomy has been reported to achieve precise reconstruction, but large carcinologic tongue defects remain extremely challenging to treat. The aim of this pilot study was to explore an anatomy-based flap design for precision subtotal tongue reconstruction.
Thirty-five patients were randomly divided into two groups, a "five-points eight-line-segments" (FIPELS) technique flap design group (18 patients) and a conventional surgery group (17 patients), to undergo subtotal tongue reconstruction. All patients received an anterolateral thigh flap with nerve coaptation to the lingual or glossopharyngeal nerve. Swallowing function, speech intelligibility, and cosmetic results were assessed with a Likert scale, and epicritic and proprioceptive sensitivity and thermosensation of the neotongue were investigated. Outcomes were analyzed, and a p-value < 0.05 was considered significant.
The FIPELS flaps were significantly larger than conventionally designed flaps. All flaps healed uneventfully, except in two patients who presented with partial necrosis. Relative to patients in the conventional group, patients in the FIPELS group showed significantly improved swallowing function (p = 0.043) and cosmetic results (p = 0.017) but not speech intelligibility (p = 0.154). Patients in the two groups recovered comparably in terms of epicritic and proprioceptive sensitivity and thermosensation.
The anatomy-based FIPELS technique is an innovative and effective solution for subtotal tongue reconstruction.
基于实际舌解剖结构的无皮瓣设计已被报道可实现精确重建，但大的癌性舌缺损仍然极具挑战性。本研究的目的是探索一种基于解剖结构的皮瓣设计，用于精确的部分舌重建。
35 名患者被随机分为两组，即“五点八线段”（FIPELS）技术皮瓣设计组（18 例）和常规手术组（17 例），行部分舌重建。所有患者均接受股前外侧皮瓣与舌神经或舌咽神经吻合。采用李克特量表评估吞咽功能、言语可懂度和美容效果，并研究新舌的表皮和本体感觉敏感性及温度感觉。分析结果，p 值<0.05 认为差异有统计学意义。
FIPELS 皮瓣明显大于常规设计皮瓣。除 2 例患者出现部分坏死外，所有皮瓣均愈合良好。与常规组患者相比，FIPELS 组患者的吞咽功能（p=0.043）和美容效果（p=0.017）明显改善，但言语可懂度（p=0.154）无明显改善。两组患者在表皮和本体感觉敏感性及温度感觉方面的恢复情况相当。
基于解剖结构的 FIPELS 技术是一种创新且有效的部分舌重建方法。
