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舌瓣作为腭裂修复术后复发性大腭瘘的挽救性手术方法。

Tongue flap as salvage procedure for recurrent and large palatal fistula after cleft palate repair.

作者信息

Prakash Advait, Singh Sangram, Solanki Shailesh, Doshi Bhavesh, Kolla Venkatesh, Vyas Tanmay, Jain Anvesh

机构信息

Department of Pediatric Surgery, Sri Aurobindo Institute of Medical Sciences and Postgraduate Institute, Indore, Madhya Pradesh, India.

出版信息

Afr J Paediatr Surg. 2018 Apr-Jun;15(2):88-92. doi: 10.4103/ajps.AJPS_131_16.

DOI:10.4103/ajps.AJPS_131_16
PMID:31290470
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6615006/
Abstract

BACKGROUND

Recurrent palatal fistula is a common complication of cleft palate repair. The main causes are poor surgical technique or vascular accidents and infection. Local flaps are not adequate for larger and recurrent fistula. The aim of this study is to analyze the utility of tongue flap in recurrent and large palatal fistula repair.

MATERIALS AND METHODS

From January 2008 to July 2016, 18 patients with recurrent palatal fistula were included in the study. All the patients had undergone repair of cleft palate and fistula previously. Tongue flap repair of the recurrent palatal fistula was performed in all 18 patients. The flaps were divided after 3 weeks and final inset was done. Flap viability, fistula closure, residual tongue function, esthetics, and speech impediment were assessed.

RESULTS

In all the patients, fistula could be closed primarily by tongue flap. None of the patients developed flap necrosis while flap dehiscence and bleeding were observed in one patient each. No functional deformity of the tongue and donor-site morbidity was seen. Speech was improved in 80% cases.

CONCLUSION

The central position, mobility, excellent vascularity, and versatility of tongue flap make particularly suitable choice for the repair of large fistula in palates scarred by previous surgery. It is very well tolerated by children. We, therefore, recommend tongue flap for large and recurrent palatal fistula in children.

摘要

背景

复发性腭瘘是腭裂修复术后的常见并发症。主要原因是手术技术欠佳、血管意外和感染。局部皮瓣不适用于较大的复发性瘘管。本研究的目的是分析舌瓣在复发性和大型腭瘘修复中的应用价值。

材料与方法

2008年1月至2016年7月，18例复发性腭瘘患者纳入本研究。所有患者均曾接受过腭裂和瘘管修复术。18例患者均采用舌瓣修复复发性腭瘘。3周后将皮瓣断蒂，完成最终植入。评估皮瓣存活情况、瘘管闭合情况、残余舌功能、美观程度及言语障碍情况。

结果

所有患者的瘘管均可通过舌瓣一期闭合。无一例患者发生皮瓣坏死，仅1例患者出现皮瓣裂开和出血情况。未见舌部功能畸形及供区并发症。80%的患者言语功能得到改善。

结论

舌瓣的中心位置、可动性、良好的血供及多功能性使其成为修复既往手术瘢痕化腭部大型瘘管的特别合适选择。儿童对其耐受性良好。因此，我们推荐使用舌瓣修复儿童大型复发性腭瘘。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/b69ea46536bd/AJPS-15-88-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/b98f3c8b076b/AJPS-15-88-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/bc1e2a49c7c4/AJPS-15-88-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/faf0958e295a/AJPS-15-88-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/3252a31ea1d1/AJPS-15-88-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/4254b4acd3af/AJPS-15-88-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/b42d62aa5a33/AJPS-15-88-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/228df1e620f5/AJPS-15-88-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/2ef8af419254/AJPS-15-88-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/17b2a2c20dd6/AJPS-15-88-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/b69ea46536bd/AJPS-15-88-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/b98f3c8b076b/AJPS-15-88-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/bc1e2a49c7c4/AJPS-15-88-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/faf0958e295a/AJPS-15-88-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/3252a31ea1d1/AJPS-15-88-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/4254b4acd3af/AJPS-15-88-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/b42d62aa5a33/AJPS-15-88-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/228df1e620f5/AJPS-15-88-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/2ef8af419254/AJPS-15-88-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/17b2a2c20dd6/AJPS-15-88-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08dc/6615006/b69ea46536bd/AJPS-15-88-g010.jpg

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Craniomaxillofac Trauma Reconstr. 2012 Sep;5(3):145-60. doi: 10.1055/s-0032-1313352.
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Descriptive study of management of palatal fistula in one hundred and ninety-four cleft individuals.194例腭裂患者腭瘘治疗的描述性研究
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Eplasty. 2023 Feb 1;23:e7. eCollection 2023.
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