Yi Liang, Li Zan
Department of Breast Oncology and Plastic Surgery, Hunan Provincial Cancer Hospital, Changsha Hunan, 410000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Sep 15;39(9):1137-1142. doi: 10.7507/1002-1892.202507082.
To explore the technical key points and effectiveness of the facial artery perforator myomucosal flap (FAPMF) in repairing oral and perioral tissue defects.
Between June 2023 and December 2024, 8 patients with oral and perioral tissue defects were repaired with the FAPMF. There were 4 males and 4 females, with an average age of 57.6 years (range, 45-72 years). Among them, 4 cases had floor-of-mouth defects and 3 cases had buccal mucosa defects remaining after squamous cell carcinoma resection, and 1 case had lower lip defect caused by trauma. The size of tissue defects ranged from 4.5 cm×3.0 cm to 6.0 cm×5.0 cm. The preoperative mouth opening was (39.55±1.88) mm, and the preoperative swallowing score of the University of Washington Quality of Life Questionnaire (UW-QOL) was 64.64±8.47. Preoperatively, CT angiography and Doppler ultrasound were used to locate the perforator vessels. A myomucosal flap pedicled with the perioral perforators of the facial artery was designed, with the harvesting size ranging from 4.0 cm×2.5 cm to 6.5 cm×4.0 cm. The length of the vascular pedicle was 4.2-6.8 cm (mean, 5.2 cm). Postoperatively, FAPMF survival, complications, and functional recovery were observed.
All 8 surgeries were successfully completed without conversion to other repair methods or complications such as facial nerve injury. The total operation time ranged from 110 to 180 minutes, with an average of 142.5 minutes; among this, the harvesting time of the FAPMF ranged from 35 to 65 minutes, with an average of 48.7 minutes. The intraoperative blood loss was 50-150 mL, with an average of 85.6 mL. All FAPMFs survived completely. One patient developed venous reflux disorder at 24 hours after operation, which relieved after conservative treatment. All patients were followed up 7-16 months (mean, 12.4 months). All FAPMFs achieved complete epithelialization at 3 months after operation, showing a similar soft texture to the surrounding mucosa. At 7 months after operation, the mouth opening was (39.11±1.79) mm, slightly lower than preoperative level, but the difference was not significant (>0.05). The swallowing score of the UW-QOL was 63.78±8.31, which was significantly lower than preoperative score (<0.05). The visual analogue scale (VAS) score for patient satisfaction was 7-10, with an average of 8.9.
The FAPMF has advantages such as reliable blood supply, high mucosal matching degree, and concealed donor site, making it an ideal option for repairing small and medium-sized oral and perioral tissue defects.
探讨面动脉穿支肌黏膜瓣（FAPMF）修复口腔及口周组织缺损的技术要点及疗效。
2023年6月至2024年12月，对8例口腔及口周组织缺损患者采用FAPMF进行修复。其中男性4例，女性4例，平均年龄57.6岁（范围45 - 72岁）。其中4例为舌底缺损，3例为鳞状细胞癌切除术后颊黏膜缺损，1例为外伤导致的下唇缺损。组织缺损大小为4.5 cm×3.0 cm至6.0 cm×5.0 cm。术前开口度为（39.55±1.88）mm，术前华盛顿大学生活质量问卷（UW-QOL）吞咽评分为64.64±8.47。术前采用CT血管造影和多普勒超声定位穿支血管。设计以面动脉口周穿支为蒂的肌黏膜瓣，切取大小为4.0 cm×2.5 cm至6.5 cm×4.0 cm。血管蒂长度为4.2 - 6.8 cm（平均5.2 cm）。术后观察FAPMF存活情况、并发症及功能恢复情况。
8例手术均顺利完成，未转为其他修复方式，未发生面神经损伤等并发症。总手术时间为110至180分钟，平均142.5分钟；其中FAPMF切取时间为35至65分钟，平均48.7分钟。术中出血量为50 - 150 mL，平均85.6 mL。所有FAPMF均完全存活。1例患者术后24小时出现静脉回流障碍，经保守治疗后缓解。所有患者随访7 - 16个月（平均12.4个月）。所有FAPMF术后3个月均实现完全上皮化，质地与周围黏膜相似。术后7个月，开口度为（39.11±1.79）mm，略低于术前水平，但差异无统计学意义（>0.05）。UW-QOL吞咽评分为63.78±8.31，显著低于术前评分（<0.05）。患者满意度视觉模拟量表（VAS）评分为7 - 10分，平均8.9分。
FAPMF具有血供可靠、黏膜匹配度高、供区隐蔽等优点，是修复中小型口腔及口周组织缺损的理想选择。
