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目的探讨不同形式游离股深动脉蒂嵌合穿支肌皮瓣的临床解剖及其在舌癌术后缺损修复中的应用。方法 2011年4月—2016年1月,采用不同形式股深动脉蒂嵌合穿支肌皮瓣修复44例舌癌术后缺损。男40例,女4例;年龄32~71岁,平均46.3岁。原发舌缘24例,舌腹17例,口底癌累及舌3例。病理类型均为鳞状细胞癌;按国际抗癌联盟(UICC)TNM分期:T4N0M0 16例,T4N1M0 11例,T3N1M0 9例,T3N2M0 8例。病程1~22个月,平均8.6个月。皮瓣切取范围为8.5 cm×4.0 cm~12.0 cm×6.5 cm,肌瓣切取范围为4.0 cm×3.0 cm~7.5 cm×5.0 cm。其中11例采用游离股深动脉蒂嵌合穿支大收肌肌皮瓣,大收肌穿支血管蒂长度为(8.3±0.5)cm;33例采用游离股深动脉蒂嵌合穿支股薄肌肌皮瓣,股薄肌穿支血管蒂长度为(8.1±0.8)cm。大腿内侧供区均直接拉拢缝合。结果术后游离股深动脉蒂嵌合穿支肌皮瓣均顺利成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合。所有患者均获随访,随访时间12~40个月,平均23.8个月。所有患者再造舌形态良好,舌体活动可,吞咽和语言功能恢复满意,无1例肿瘤局部复发。大腿内侧瘢痕位置隐蔽,仅遗留线状瘢痕。结论游离股深动脉蒂嵌合穿支肌皮瓣可以以不同形式切取,适用于舌癌术后缺损修复。
Objective To investigate the clinical anatomy of different forms of deep femoral artery pedicled with pedicled peroneal flap and its application in the repair of tongue cancer after operation. Methods From April 2011 to January 2016, 44 cases of tongue cancer postoperative defect were treated with different forms of deep femoral pedicel pedicle flap. 40 males and 4 females; aged 32 to 71 years, mean 46.3 years old. 24 cases of primary tongue, tongue belly in 17 cases, 3 cases of mouth cancer involving the tongue. Pathological types were squamous cell carcinoma; According to the International Union Against Cancer (UICC) TNM staging: T4N0M0 16 cases, T4N1M0 11 cases, T3N1M0 9 cases, T3N2M0 8 cases. Duration of 1 ~ 22 months, an average of 8.6 months. Skin flap range of 8.5 cm × 4.0 cm to 12.0 cm × 6.5 cm, muscle flap cut range of 4.0 cm × 3.0 cm ~ 7.5 cm × 5.0 cm. In 11 of them, the free pedicel pedicel pedicled adductor myocutaneous flap was used, and the length of adductor pedicel pedicle was (8.3 ± 0.5) cm. In 33 cases, Musculocutaneous flap and gracilis perforating pedicle length was (8.1 ± 0.8) cm. Thigh area for the area are directly drawn suture. Results The free deep femoral artery pedicled pedicled pedicle flap survived successfully and the wound was healed in the first stage. All the wounds were healed by first intention. All patients were followed up for 12 to 40 months with an average of 23.8 months. All patients had good reconstruction tongue morphology, tongue activity, swallowing and language function satisfaction, none of the tumor local recurrence. The location of the inner thigh hidden scars, leaving only linear scars. Conclusion Free deep femoral artery pedicle flap pedicle flap can be cut in different forms and is suitable for the repair of tongue cancer postoperative defect.