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目的探索更为理想的穿支游离皮瓣修复技术,运用于头颈肿瘤术后缺损。方法2003年12月~2005年5月用于头颈部手术缺损修复的穿支游离皮瓣共14例(股前外侧皮瓣8例,腹壁下深动脉穿支皮瓣6例)。其中10例为复发后挽救手术,12例曾行放疗(平均63.5Gy)。头颈部肿瘤手术缺损部位分别为舌体3例,颊黏膜3例,口咽壁3例,舌根2例,颅底、头皮以及中面部各1例。受区供吻合动脉主要是甲状腺上动脉和面动脉;静脉为颈内静脉。结果13例穿支游离皮瓣成功(93%),有1例穿支皮瓣因吻合侧的颈内静脉血栓形成导致皮瓣坏死。受区未发现其它明显并发症。供区均直接缝合关闭并一期愈合,未发现腹壁疝和运动受限等手术并发症。结论穿支游离皮瓣保留了供区的肌肉、筋膜和神经,将供区的并发症降到最低限度,是头颈部缺损修复新的可靠技术。
Objective To explore a more ideal perforation free flap repair technique for the treatment of postoperative head and neck cancer. Methods From December 2003 to May 2005, 14 cases of perforation free flap for the repair of head and neck surgery (8 cases of anterolateral thigh flap and 6 cases of deep perforator flap of abdominal wall) were treated. Of these, 10 were salvage surgery after recurrence and 12 had radiotherapy (mean, 63.5 Gy). Head and neck tumor surgery were 3 cases of tongue defects, buccal mucosa in 3 cases, 3 cases of oropharyngeal wall, tongue base in 2 cases, skull base, scalp and the middle of the face in 1 case. The area for anastomosis is mainly thyroid artery and facial artery; vein for the internal jugular vein. Results Thirteen patients (93%) had perforation of the free flap, and one had perforator flap due to an anastomotic thrombosis of the internal jugular vein leading to necrosis of the flap. The affected area found no other obvious complications. For the area are directly sutured closed and a healing, no abdominal wall hernia and limited movement and other surgical complications. CONCLUSION: The perforation free flap preserves the muscles, fascia and nerves in the donor area and minimizes the complications of the donor area. It is a new reliable technique for the repair of head and neck defects.