旋髂浅动脉穿支皮瓣修复颊-咽-腭缺损的临床应用

摘要

目的 探讨旋髂浅动脉穿支皮瓣修复磨牙后区咽旁鳞状细胞癌根治术后颊部-咽旁-腭部复合性缺损的临床效果.方法 2014年1月至2017年1月,应用旋髂浅动脉穿支皮瓣修复8例咽旁鳞状细胞癌根治术后颊部-咽旁-腭部复合性缺损,所有患者术前均进行CT血管造影及彩色多普勒超声检查.根据受区缺损大小,以影像学定位的穿支血管为中心,仔细制备皮瓣并转移至颊部-咽旁-腭部复合性缺损处,显微镜下成功吻合动静脉后严密缝合受区及供区,术后观察皮瓣的存活及功能恢复情况.结果 旋髂浅动脉穿支皮瓣面积5 cm×6 cm ～7 cm×9 cm,动脉平均管径0.65 mm,静脉平均管径1.2 mm,动静脉血管蒂平均长度分别为7.1 cm和8.1 cm,8例皮瓣全部成活,术后颊部-咽旁-腭部形态良好,张口度正常.结论 旋髂浅动脉穿支皮瓣质地柔软,穿支血管蒂较长,供区瘢痕隐蔽,是修复磨牙后区咽旁鳞癌术后缺损的良好选择.%Objective To investigate the therapeutic effect of free superficial circumflex iliac artery perforator (SCIP) flap for reconstruction of soft tissue defects secondary to resection of retromolar and lateral buccal squamous cell carcinoma.Methods From January 2014 to January 2017,eight patients with retromolar and lateral buccal squamous cell carcinoma received radical resection and reconstructed with SCIP flap immediately.CTA and color Doppler sonography were routinely performed before the surgery.According to the size of the defect in the recipient area,the flap vascularized by the perforator vessel was carefully prepared and transferred to the buccal-pharynx-palate composite defect.The recipient area and donor area were sutured tightly after arteriovenous anastomosis under microscope.The survival and functional recovery of the flap were observed after operation.Results The flap sizes ranged from 5 cm × 6 cm to 7 cm × 9 cm.The mean diameter of the superficial circumflex iliac arteries was 0.65 mm.And the mean diameter of the veins was 1.2 mm.The mean arterial pedicle length was 7.0 cm,and the venous pedicle length was 8.0 cm.Eight flaps were all survived.The shape of the buccal-parapharyngeal-palate was good and the mouth opening was normal after operation.Conclusions Superficial circumflex iliac artery perforator flap was a good choice for repairing the defect of parapharyngeal squamous cell carcinoma in the posterior molar region.