Wang Z H, Fu G M, Chen Y B, Li X J, Wan Q X, Chen J, Cai Y C, Li C H
Department of Head and Neck Surgery, Sichuan Cancer Hospital, Sichuan Institute of Cancer Research, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Dec 7;54(12):907-911. doi: 10.3760/cma.j.issn.1673-0860.2019.12.005.
To explore the advantages and clinical efficacy of free chimeric perforator flap based on the descending branch of circumflex femoral artery applied to tongue reconstruction after advanced tongue cancer resection. From October 2013 to December 2018, 57 cases received tongue and oral base reconstruction surgeries using the descending branch of circumflex femoral artery chimeric perforator flap, including 39 males and 18 females, ranged from 20 to 76 years old. And all cases were with stage T3 and T4 tongue cancers, including 35 cases of squamous cell carcinoma, 7 cases of low differentiation cancer, 5 cases of oncosarcoma, and 10 cases of adenoid cystic carcinoma. The tongue was reconstructed by using perforator flap and muscle flap to fill the dead space at the oral floor. The artery anastomoses with the superior thyroid artery or facial artery in the receiving area, and the vein anastomoses with the internal jugular vein in the receiving area. The shape, function and local complications of the reconstructed tongue were observed after operation. Of 57 cases, only one case had partial necrosis of flap, while other 56 cases with chimeric perforator flap survived. Postoperative gastric tube and tracheal cannula were removed in all patients, no cases with oral fistula. All donor sites were sutured in one stage. Postoperative radiotherapy was performed in 41 of the patients. All patients were followed up for 3 to 60 months (average of 20.7 months), with satisfactory esthetic and functional results in reconstructed tongues. Only linear scars were left in the donor areas of the legs, and no lower limb dysfunction was observed. The descending branch of circumflex femoral artery chimeric perforator flap can used for repairing simultaneously the defects of both tongue and oral base. It is helpful to avoid the occurrence of oral fistula and to provide the reconstructed tongue with a good function. It is a good choice to use the descending branch of circumflex femoral artery chimeric perforator flap for tongue reconstruction after resection of advanced tongue cancer resection.
探讨旋股动脉降支游离嵌合穿支皮瓣应用于晚期舌癌切除术后舌重建的优势及临床疗效。2013年10月至2018年12月，57例患者采用旋股动脉降支嵌合穿支皮瓣行舌及口底重建手术，其中男性39例，女性18例，年龄20～76岁。所有病例均为T3、T4期舌癌，其中鳞状细胞癌35例，低分化癌7例，骨肉瘤5例，腺样囊性癌10例。采用穿支皮瓣和肌皮瓣修复舌缺损，填充口底死腔。动脉在受区与甲状腺上动脉或面动脉吻合，静脉与受区内颈静脉吻合。术后观察重建舌的形态、功能及局部并发症。57例中仅1例皮瓣部分坏死，其余56例嵌合穿支皮瓣全部成活。所有患者术后均拔除胃管及气管套管，无口瘘发生。所有供区均一期缝合。41例患者术后行放疗。所有患者随访3～60个月（平均20.7个月），重建舌的美观和功能效果满意。供区下肢仅留线性瘢痕，未观察到下肢功能障碍。旋股动脉降支嵌合穿支皮瓣可同时修复舌及口底缺损，有助于避免口瘘发生，为重建舌提供良好功能。旋股动脉降支嵌合穿支皮瓣是晚期舌癌切除术后舌重建的良好选择。
