1212块股前外侧肌皮瓣在口腔颌面缺损修复中的应用

摘要

Objective  To examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects. Methods  Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1 185 patients, 1 212 transferred flaps) underwent reconstruc-tive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed. Results  Among the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time for anastomosis of one vein was significantly less than that for two veins (P=0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the sur-vival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05). Conclusion  Anterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.%目的：  探讨游离股前外侧肌皮瓣在口腔颌面部修复重建的价值。方法  收集2002年2月—2013年6月间在中南大学湘雅二医院口腔颌面外科住院，进行了股前外侧肌皮瓣修复的患者1 185例（1 212块皮瓣）。记录并统计患者的基本资料、缺损部位、皮瓣的面积及类型、受区血管的处理方法、供区并发症、患者术后生存质量等情况。结果  1 212块皮瓣成活1 176块，坏死36块，成活率97.0%。皮瓣供区无严重并发症出现。股前外侧肌皮瓣重建口腔颌面部各个部位的缺损后，90%以上的患者得到了良好的功能恢复及美观效果。吻合1根静脉与吻合2根静脉相比，可以显著地缩短显微操作时间（P=0.0003）。2组的静脉危象发生率、抢救成功率及静脉危象导致的皮瓣坏死率均无统计学差异（P>0.05）。结论  股前外侧肌皮瓣组织供应量大，可满足口腔颌面部各个部位缺损的修复要求。股前外侧肌皮瓣比其他游离皮瓣，更适合用于口腔颌面部缺损修复，应作为首选皮瓣。