Close L G, Truelson J M, Milledge R A, Schweitzer C
Department of Otorhinolaryngology, University of Texas Southwestern Medical Center at Dallas, USA.
Arch Otolaryngol Head Neck Surg. 1995 Sep;121(9):967-72. doi: 10.1001/archotol.1995.01890090011002.
To assess the clinical recovery of sensation in noninnervated flaps used for oral cavity and oropharyngeal reconstruction. To correlate the return of flap sensation to articulation and swallowing.
Prospective nonrandomized study. Six months minimum follow-up.
Tertiary care center.
From April 1, 1991, to May 31, 1993, 12 patients underwent resection of stage III or greater squamous cell carcinoma of the oral cavity or oropharynx. Ten patients were previously untreated; two had failed previous full-course radiation therapy. Reconstruction was performed with either a pedicled musculocutaneous flap (four patients) or a fasciocutaneous free flap (eight patients). Flap sensation to touch, sharp vs dull, two-point discrimination, and warm vs cold was evaluated in each of these patients at monthly intervals by two independent observers. In addition, an extensive evaluation of articulation and swallowing was performed on all 12 patients a minimum of 6 months after surgery. 10 patients (83%) (eight of eight with fasciocutaneous free flaps and two of four with musculocutaneous flaps), with a strong trend for sensory recovery with the fasciocutaneous free flaps over the musculocutaneous flaps (P = .09). Sensory recovery correlated statistically with articulation (P = .045) and oral intake (P = .045). Patients who underwent reconstruction of base of tongue defects had significantly worse articulation and swallowing than those who underwent reconstruction of other sites (P = .04). No statistically significant correlation was found between patient age, flap size, history of irradiation, or length of follow-up (> 6 months) and flap sensation, articulation, or swallowing.
Spontaneous return of flap sensation was documented by clinical testing in the majority (83%) of patients who underwent reconstruction of oral cavity or oropharyngeal defects with noninnervated flaps. Sensory recovery occurred more often in patients with fasciocutaneous free flaps (100%) than in those with musculocutaneous flaps (50%). Articulation and swallowing correlated statistically with the return of flap sensation.
评估用于口腔和口咽重建的无神经支配皮瓣的感觉临床恢复情况。将皮瓣感觉的恢复与发音和吞咽功能相关联。
前瞻性非随机研究。至少随访6个月。
三级医疗中心。
1991年4月1日至1993年5月31日，12例患者接受了口腔或口咽III期或更高级别鳞状细胞癌的切除术。10例患者此前未接受过治疗；2例曾接受过全程放疗但失败。采用带蒂肌皮瓣（4例患者）或游离筋膜皮瓣（8例患者）进行重建。由两名独立观察者每月对这些患者的皮瓣触觉、锐痛与钝痛、两点辨别觉以及温觉与冷觉进行评估。此外，在所有12例患者术后至少6个月时对发音和吞咽功能进行全面评估。10例患者（83%）（8例游离筋膜皮瓣患者中的8例以及4例带蒂肌皮瓣患者中的2例），游离筋膜皮瓣的感觉恢复趋势强于带蒂肌皮瓣（P = 0.09）。感觉恢复与发音（P = 0.045）和经口进食（P = 0.045）在统计学上相关。接受舌根缺损重建的患者发音和吞咽功能明显比接受其他部位重建的患者差（P = 0.04）。在患者年龄、皮瓣大小、放疗史或随访时间（> 6个月）与皮瓣感觉、发音或吞咽功能之间未发现统计学上的显著相关性。
通过临床测试证实，大多数（83%）接受无神经支配皮瓣进行口腔或口咽缺损重建的患者皮瓣感觉能自发恢复。游离筋膜皮瓣患者（100%）的感觉恢复比带蒂肌皮瓣患者（50%）更常见。发音和吞咽功能与皮瓣感觉的恢复在统计学上相关。
