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目的探讨带蒂和游离组织瓣移植同期修复口腔颌面部癌术后缺损的适应证和注意事项。方法 2010年1月至2011年8月采用自体组织移植同期修复口腔颌面部癌术后缺损31例,采用游离组织瓣20例,其中挠侧前臂皮瓣18例,腓骨肌皮瓣2例;带蒂胸大肌肌皮瓣11例。术后观察皮瓣成活率、并发症和近期疗效。结果 31例皮瓣有前臂皮瓣1例坏死,1例部分坏死;胸大肌肌皮瓣1例部分坏死;其余组织瓣全部成活,血管危象:前臂皮瓣2例,经抢救后成活;胸大肌肌皮瓣3例感染,控制感染后皮瓣成活。术后随访2～18个月,复发2例,1例术后3个月死亡。本组病例除死亡患者外,3例对治疗效果不满意,其余27例满意。结论组织瓣同期移植修复可扩大口腔颌面部癌的手术适应证,提高患者的生存质量;保证血供和静脉回流是皮瓣成活的关键。
Objective To investigate the indications and precautions of reconstructing the postoperative defect of oral and maxillofacial carcinoma with pedicle and free flap transplantation in the same period. Methods From January 2010 to August 2011, 31 cases of oral and maxillofacial cancerous defects were reconstructed by autologous tissue transplantation in the same period. There were 20 cases of free flap, including 18 cases of flexible forearm flap and 2 cases of fibular myocutaneous flap. Pedunculated pectoralis major myocutaneous flap in 11 cases. Postoperative flap survival rate, complications and short-term efficacy. Results There were 1 case of necrosis of forearm flap and 1 case of partial necrosis in 31 cases. One case of pectoralis major myocutaneous flap was partially necrotic. The rest of the flap survived. Vascular crisis: 2 cases of forearm flap survived the rescue. 3 cases of pectoralis major myocutaneous infection, control the flap survival after infection. The patients were followed up for 2 to 18 months, 2 cases were relapsed and 1 case died after 3 months. In addition to the death of patients in this group, 3 patients were not satisfied with the treatment, the remaining 27 patients were satisfied. Conclusions Simultaneous transplantation of tissue flap can augment operative indications of oral and maxillofacial carcinoma and improve quality of life of patients. Ensuring blood supply and venous return is the key to flap survival.