Papadopoulos O N, Gamatsi I E
Second Propedeutic Surgical Department of Athens University School of Medicine, Greece.
Ann Plast Surg. 1993 Jul;31(1):15-8.
Different procedures have been described for facial and oral reconstruction after malignant tumor removal, such as skin grafts and local and distal staged flaps. Myocutaneous island or free flaps are the method of choice for these reconstructions. Our experience concerns the use of the platysma myocutaneous flap in 12 patients after intraoral and extraoral malignant tumor resection. Six patients had squamous cell carcinomas, i.e., 2 malignant melanomas of the skin and 4 squamous cell carcinomas of the oral mucosa. The complete tumor resection was controlled by frozen-section biopsy in all patients, but for 7 of them a functional or radical neck dissection was performed. We suggest including in the flap the external jugular vein. The results were evaluated from an oncological, functional, and aesthetic point of view. We noticed 2 recurrences in a minimum follow-up of 4 years. The functional and aesthetic results were quite satisfactory and no serious complications were noticed in our series. However, the primary disadvantage of this interesting flap is that the dominant vasculature derived from the submental branch of the facial artery is seldom visualized. In spite of this, it should be regarded as very useful for limited intraoral or surface coverage problems in an arc extending 10 cm from the level of the facial artery at the mandible. This arc includes the cheek, the lower lip, the chin, the floor of the mouth, and the mastoid area.
对于恶性肿瘤切除后的面部和口腔重建，已经描述了不同的手术方法，如皮肤移植以及局部和远端分期皮瓣。肌皮岛状瓣或游离瓣是这些重建手术的首选方法。我们的经验涉及在12例口腔内和口腔外恶性肿瘤切除术后使用颈阔肌肌皮瓣。6例患者患有鳞状细胞癌，即2例皮肤恶性黑色素瘤和4例口腔黏膜鳞状细胞癌。所有患者均通过冰冻切片活检控制肿瘤完全切除，但其中7例患者进行了功能性或根治性颈清扫术。我们建议在皮瓣中包含颈外静脉。从肿瘤学、功能和美学角度对结果进行评估。在至少4年的随访中，我们注意到2例复发。功能和美学结果相当令人满意，并且在我们的系列中未发现严重并发症。然而，这种有趣皮瓣的主要缺点是很少能看到源自面动脉颏下支的主要血管。尽管如此，对于下颌骨处面动脉水平向外延伸10厘米的弧形范围内有限的口腔内或表面覆盖问题，它仍应被视为非常有用。这个弧形区域包括脸颊、下唇、下巴、口腔底部和乳突区。
