Oral carcinoma；Platysma myocutaneous flap；Defect repair
Objective To report 4 methods of reconstructing soft tissue defects in oral and maxillofacial regions after tumors resection using cervical pedicle tissue flaps. Methods One hundred seventy-two soft tissue defects were repaired with cervical myocutaneous flaps after resection of oral and facial cancer( 165 cases of squamous cell carcinoma and 7 cases of salivary carcinoma). The clinical stage of the tumors was stage Ⅰ in 21 cases, stage Ⅱ in 116 cases and stage Ⅲin 35 cases. Primary sites of the lesions were the tongue (59 cases), buccal mucosa (55 cases), lower gingiva (26 cases), floor of the mouth (25 cases), parotid gland (4 cases) and oropharynx (3 cases). Infrahyoid myocutaneous flaps were used in 60 cases, platysma flaps in 45 cases, sternocleidomastoid flaps in 59 cases and submental island flaps in 8 cases. The sizes of skin paddle ranged from 2.5 cm×5.0 cm to 5.0 cm ×8.0 cm. Results Among 153 survival flaps, there were55 infrahyoid myocutaneous flaps, 40 platysma flaps, 52 sternocleidomastoid flaps and 6 submental island flaps. There were 11 cases of total flap necrosis and8 cases of partial flap necrosis. The success rates were 91.67%(55/60) for infrahyoid myocutaneous flap, 88.89%(40/45) for platysma flap, 88.14% (52/59) for sternocleidomastoid flap and 75%(6/8) for submental island flap. After a follow-up of 3 11 years(5.7 years on average) among 101 cases local reccurence in 18 cases, cervical reccurence in 4 cases, distance metastasis in 2 cases. The survical rate at 3 years were 83.17%(84/101). Conclusion Cervical pedicle tissue flaps haveclinical value in reconstruction of small and medium-sized soft tissue defects after resection of oral and maxillofacial tumors.
ObjectiveTo investigate the feasibility of the bipaddled split pectoralis major myocutaneous flap for immediate reconstruction of oral mucosal defects and neck defects after resection of recurrent oral cancer. MethodsSix patients with oral mucosal defects combined with neck defects after recurrent oral cancer resection were treated with bipaddled split pectoralis major myocutaneous flap between September 2013 and September 2014. There were 5 males and 1 female with an average age of 54.7 years (range, 45-62 years), including 4 cases of recurrent tongue cancer, 1 case of recurrent mandibular gingival cancer, and 1 case of mouth floor carcinoma. All patients underwent local recurrence at 8 to 14 months after first operation, with no distant metastasis. The defects of the intraoral mucosa was 4.0 cm×2.5 cm to 6.5 cm×3.5 cm and the defect of the neck skin was 5.5 cm×3.5 cm to 7.5 cm×5.0 cm. The pectoralis major myocutaneous flaps (14.0 cm×3.5 cm to 17.0 cm×5.5 cm) were incised at the level of the 3rd to the 4th rib, and then split down along the muscle fiber till about 2 cm away from the thoracoacromial vessels, forming 2 independent skin paddles with 1-2 branch vessels to the pedicles of the distal ones. The distal skin paddles were used for oral reconstruction while the proximal paddles for repair of neck defects. The chest donor sites were sutured directly. ResultsCervical haematoma and infection happened in 1 patient respectively after operation, and were cured after symptomatic treatment. All 6 split pectoralis major myocutaneous flaps with 12 skin paddles completely survived. All patients were followed up 6 to 18 months (mean, 11 months). One patient died of pulmonary metastasis at 8 months after operation and the other 5 survived without relapse or metastasis during follow-up. The intraoral paddles showed good shape with satisfactory speech function and swallowing recovery. The paddles also healed perfectly on the neck with flat outlooks, and all patients obtained full appearance and free movement of the neck. No fistula formed on the submandibular region and neck. ConclusionThe bipaddled split pectoralis major myocutaneous flap can complete simultaneous immediate reconstruction of oral mucosal defect and neck defect. It is very useful in the treatment of recurrent oral cancer.
【摘要】 目的 〖JP2〗探討護理干預對前臂游離皮瓣移植修復口腔癌圍手術期軟組織缺損患者的經驗。 方法 2005年6月—2009年6月，對收治的63例口腔癌術后軟組織缺損應用前臂橈側游離皮瓣修復患者的圍手術期護理方法進行回顧性分析，并做好術前心理護理及相關準備，術后嚴密觀察皮瓣移植情況，以便及時發現血管危象，同時做好口腔、呼吸道、體位及皮瓣供受區護理。 結果 通過精心護理，密切觀察移植皮瓣，及早發現、及時處理血管危象，從而確保63例患者皮瓣移植一次性成活率達95.24%，療效滿意。 結論 科學合理的圍手術期護理是前臂游離皮瓣移植修復口腔癌術后軟組織缺損成功的重要保證。【Abstract】 Objective To investigate the perioperative nursing experiences of the transplanted forearm free flaps for reconstruction of soft tissue defects after oral cancer operation. Methods We retrospectively analyzed the clinical data of perioperative nursing care for 63 patients with soft tissue defects after oral cancer reconstructed with radial forearm free flaps. Psychological care and related preparation work was well carried out before operation. After operation, we closely monitored the outcome of transplantation of skin flaps to detect vascular crisis as early as possible, and at the same time, intensive care for oral cavity, respiratory tract, flap position and the affected areas was done. Results By intensive care, closely monitoring the transplanted flaps, and early discovery and management of the vascular crisis, we achieved a satisfying one-time transplantation survival rate of 95.24% for the 63 patients. Conclusion Scientific and proper perioperative care is an important factor in the successful reconstruction of soft tissue defects with free forearm flaps after oral cancer operation.
目的:組織瓣修復缺損是頭頸部腫瘤切除術中的重要手段和必要環節。本研究總結65例頰癌和口咽癌不同范圍組織缺損用局部帶蒂組織瓣的修復方法。方法: 回顧2001~2009年我科65例口腔頰癌及口咽癌切除術后選擇腭瓣、頦下瓣、面動脈逆行皮瓣、頰脂墊頰肌復合瓣修復頰部及口咽部組織缺損,病變范圍和治療結果。結果: 65例皮瓣中,17例腭瓣全部成活,29例頦下瓣26例全部成活,2例部分壞死,1例表層皮膚壞死, 7例面動脈逆行皮瓣6例全部成活,1例壞死,12例頰脂墊或頰脂墊頰肌復合瓣全部成活11例,1例部分壞死,總成活率96.9％。31例患者術后有不同程度的張口受限,咀嚼和吞咽功能基本正常。結論: 根據頰癌和口咽癌的病變范圍決定采用不同的臨近帶蒂組織瓣修復缺損,修復效果確切,可以明顯減少手術創傷和術后并發癥,尤其適用于年老及較多基礎疾病患者,仍應作為頭頸部腫瘤術后缺損修復的重要方法。