阔筋膜-股前外侧皮瓣复合移植修复颌面部根治性肿瘤切除术后复杂缺损的临床效果

韩飞; 张万福; 佟琳; 焦静龙; 陈阳; 张月; 官浩

doi:10.3760/cma.j.cn501225-20240801-00290

阔筋膜-股前外侧皮瓣复合移植修复颌面部根治性肿瘤切除术后复杂缺损的临床效果

doi: 10.3760/cma.j.cn501225-20240801-00290

空军军医大学第一附属医院全军烧伤中心,烧伤与皮肤外科,西安　710032

基金项目:

陕西省重点研发计划项目 2024SF-ZDCYL-04-10

详细信息

通讯作者:
官浩,Email：guanhao2020@yeah.net

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出版历程
- 收稿日期: 2024-08-01

Clinical efficacy of composite transplantation of fascia lata-anterolateral thigh flap in repairing complex defects after radical tumor resection in maxillofacial region

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

Shaanxi Provincial Key Research and Development Program of China 2024SF-ZDCYL-04-10

More Information

Corresponding author: Guan Hao, Email: guanhao2020@yeah.net

摘要

摘要: 目的探讨阔筋膜-股前外侧皮瓣复合移植修复颌面部根治性肿瘤切除术后复杂缺损的临床效果。方法该研究为回顾性观察性研究。2023年1月—2024年1月,空军军医大学第一附属医院烧伤与皮肤外科收治12例符合入选标准的颌面部根治性肿瘤切除术后形成复杂缺损的患者,其中男7例、女5例,年龄42~60岁。根治性肿瘤切除术后,皮肤软组织缺损面积为6.0 cm×4.0 cm~11.0 cm×10.0 cm,口颊黏膜与颧弓之间的缺损面积为4.0 cm×3.0 cm~11.0 cm×5.0 cm。设计并先行切取股前外侧皮瓣（面积为7.0 cm×5 .0 cm~12.0 cm×11.0 cm）,后续再切取其下方的阔筋膜（面积为4.0 cm×3.0 cm~11.0 cm×5.0 cm）。然后,先将阔筋膜用于重建口腔衬里,再将股前外侧皮瓣用于修复遗留皮肤软组织缺损。术后观察患者皮瓣成活情况、阔筋膜作为衬里的上皮化时间、供受区创面愈合情况及受区是否存在血管危象、口腔瘘、感染等并发症。随访时,观察患者阔筋膜作为衬里的上皮化情况,检测患者张口度并评估咬合功能,观察患者面部外形及供区瘢痕情况。结果术后患者皮瓣均成活,阔筋膜作为衬里的上皮化时间为8~10 d。仅1例上颌窦鳞状细胞癌患者皮瓣边缘创口愈合不良,经换药后延期愈合；其余患者受区创面愈合良好。供区创面均愈合良好。受区未发生血管危象、口腔瘘、感染等并发症。随访3个月,患者口腔黏膜已覆盖阔筋膜表面；垂直张口度为3横指者9例、2.5横指者1例、2横指者1例、1.5横指者1例,水平张口度3~5 cm；咀嚼及吞咽功能正常。患者面容均对称,术区外形饱满；供区仅遗留线性瘢痕。结论阔筋膜-股前外侧皮瓣复合移植修复颌面部根治性肿瘤切除术后复杂缺损的效果良好,通过分步重建口腔屏障与软组织缺损,可显著降低术后并发症发生风险,实现功能恢复与美学重建。
- 显微外科手术 /
- 上颌面部损伤 /
- 阔筋膜 /
- 外科皮瓣 /
- 股前外侧皮瓣 /
- 复杂缺损 /
- 创面修复
Abstract: Objective To investigate the clinical efficacy of composite transplantation of fascia lata-anterolateral thigh flap for repairing complex defects after radical tumor resection in maxillofacial region. Methods This study was a retrospective observational study. From January 2023 to January 2024, 12 patients (7 males and 5 females, aged 42 to 60 years) meeting the inclusion criteria with complex defects after radical tumor resection in maxillofacial region were treated at the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University. After radical tumor resection, the sizes were 6.0 cm×4.0 cm to 11.0 cm×10.0 cm for skin and soft tissue defects and 4.0 cm×3.0 cm to 11.0 cm×5.0 cm for buccal mucosa-zygomatic arch defects. The anterolateral thigh flap with area ranging from 7.0 cm×5.0 cm to 12.0 cm×11.0 cm was first designed and harvested, followed by the underlying fascia lata (ranging from 4.0 cm×3.0 cm to 11.0 cm×5.0 cm). Then, the fascia lata was used first to reconstruct the oral lining, and the anterolateral thigh flap was subsequently employed to repair the residual skin and soft tissue defects. Postoperatively, the survival of the patient's flap was observed, the epithelialization time of the fascia lata used as lining was recorded, and wound healing at the donor and recipient sites was monitored, along with whether complications such as vascular crisis, oral fistula, or infection were present at the recipient site. During follow-up, the epithelialization of the fascia lata as a lining was observed, the mouth opening degree of the patient was measured, the occlusal function was evaluated, and the facial appearance and scar condition in donor site were observed. Results Postoperatively, all flaps of patients survived successfully, with the fascia lata used as a lining achieving complete epithelialization within 8-10 days. Only one patient with maxillary sinus squamous cell carcinoma experienced delayed wound healing at the flap margin, which was resolved after dressing changes; the recipient site wounds in the remaining patients healed well. All the donor site healed well. No vascular crisis, oral fistula, infection, or other complications occurred at the recipient sites. During 3 months of follow-up, the oral mucosa had covered the surface of the fascia lata; the vertical mouth opening was 3 transverse fingers in 9 cases, 2.5 transverse fingers in 1 case, 2 transverse fingers in 1 case, and 1.5 transverse fingers in 1 case, the horizontal mouth opening was 3-5 cm; chewing and swallowing functions were normal. All patients exhibited facial symmetry with the surgical area being full, and only linear scars were left in the donor sites. Conclusions The composite transplantation of fascia lata-anterolateral thigh flap demonstrates excellent efficacy in repairing complex defects after radical tumor resection in maxillofacial area. Through staged reconstruction of both the oral barrier and soft tissue defects, this approach significantly reduces the risk of postoperative complications while achieving functional recovery and aesthetic reconstruction.
- Microsurgery /
- Maxillofacial injuries /
- Fascia lata /
- Surgical flaps /
- Anterolateral thigh flap /
- Complex defects /
- Wound repair
韩飞：手术操作、论文撰写；张万福：手术设计、论文修改；佟琳：论文撰写；焦静龙、陈阳、张月：参与手术；官浩：对论文的知识性内容作批评性审阅、手术指导、论文修改和经费支持

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图 1 应用阔筋膜-股前外侧皮瓣复合移植修复患者左面部上颌窦鳞状细胞癌根治性切除术后复杂缺损的效果。1A.肿瘤切除后,可见左侧颌面部形成的皮肤软组织缺损与口腔相通；1B.创面修复术前,于患者右侧大腿设计股前外侧皮瓣；1C.创面修复术中,根据患者口颊黏膜与颧弓之间缺损切取皮瓣下方的阔筋膜；1D.将切取的阔筋膜悬吊并缝合于口颊黏膜与颧弓之间术中；1E.阔筋膜缝合完毕即刻,可见其起到隔离口腔作用,恢复口颊黏膜的完整性和连续性；1F.将皮瓣与创面周围皮肤对位缝合后即刻；1G.直接拉拢缝合供区创面后即刻；1H.术后3个月随访时显示,口腔黏膜已完全覆盖阔筋膜表面

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