Jones T R, Lee G, Emami B, Strasberg S
Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Mo., USA.
Plast Reconstr Surg. 1995 Oct;96(5):1092-9. doi: 10.1097/00006534-199510000-00013.
Ideal reconstruction of the oral cavity includes a durable lining that is thin, supple, and innervated, and that provides a lubricated surface that facilitates deglutition and speech. This paper describes the use of free colon transfer for relining the oral cavity. In three patients, segments of transverse colon, split along the antimesenteric border, were transferred as free flaps on the middle colic vessels for large defects involving the alveolar ridge, buccal mucosa, floor of the mouth, tongue, and pharyngeal walls. All flaps were transferred successfully without adverse vascular events, abdominal complications, or oro-cutaneous fistulas. One flap was re-elevated 2 weeks postoperatively for additional mandibulectomy. Two patients received postoperative radiation therapy and another patient received planned preoperative radiotherapy. The mucosal surface of the colon flattens to provide a thin, smooth, supple oral lining that produces moderate mucus, coapts well to the convoluted surfaces of the defects, and is durable to mastication and denture wear. Mucosal biopsy 2 years postoperatively in the nonradiated flap reveals normal colon mucosa with abundant mucin-producing cells. Free colon transfer is a "functional" reconstruction of the oral lining. The donor tissue is abundant and capable of resurfacing large, convoluted oral cavity surfaces with a thin, supple, mucus-secreting tissue that allows unimpaired tongue mobility, swallowing, speech, and denture wear. Furthermore, the presence of nonirradiated, mucus-secreting cells provides an avenue to further augment mucin production by topical and systemic agents.
口腔的理想重建包括一个薄、柔软且有神经支配的耐用内衬，该内衬能提供一个润滑表面，便于吞咽和说话。本文描述了使用游离结肠转移术来重新衬里口腔。在三名患者中，沿结肠系膜对侧缘劈开的横结肠段作为游离皮瓣，通过中结肠血管转移，用于修复涉及牙槽嵴、颊黏膜、口底、舌和咽壁的大缺损。所有皮瓣均成功转移，未发生不良血管事件、腹部并发症或口皮瘘。术后2周，有一个皮瓣因需进一步行下颌骨切除术而重新掀起。两名患者接受了术后放疗，另一名患者接受了计划中的术前放疗。结肠的黏膜表面变平，形成一个薄、光滑、柔软的口腔内衬，产生适量黏液，能很好地贴合缺损的复杂表面，且耐咀嚼和义齿磨损。术后2年对未接受放疗的皮瓣进行黏膜活检，显示为正常结肠黏膜，有丰富的黏液分泌细胞。游离结肠转移术是口腔内衬的一种“功能性”重建。供体组织丰富，能够用薄、柔软、分泌黏液的组织覆盖大的、复杂的口腔表面，使舌头活动、吞咽、说话和义齿佩戴不受影响。此外，未受辐射的黏液分泌细胞的存在为通过局部和全身药物进一步增加黏液分泌提供了途径。
