本文選題：游離腓腸內(nèi)側(cè)動(dòng)脈穿支皮瓣　切入點(diǎn)：舌重建　出處：《浙江大學(xué)》2014年碩士論文

【摘要】：目的： 觀察應(yīng)用游離腓腸內(nèi)側(cè)動(dòng)脈穿支皮瓣修復(fù)中小型舌癌術(shù)后缺損的臨床效果,總結(jié)臨床經(jīng)驗(yàn)。 方法： 2013年3月至2014年2月間6例舌癌患者,腫瘤根治術(shù)同期采用游離腓腸內(nèi)側(cè)動(dòng)脈穿支皮瓣修復(fù)軟組織缺損。術(shù)前采用手持多普勒檢測(cè)穿支血管,予以標(biāo)記定位,并設(shè)計(jì)皮瓣；術(shù)中根據(jù)缺損大小制作穿支皮瓣,記錄皮瓣大小、穿支血管的數(shù)目和位置以及血管蒂長(zhǎng)度；術(shù)后隨訪觀察皮瓣成活情況,記錄供區(qū)愈合情況及舌體功能恢復(fù)情況。 結(jié)果： 6例患者所移植的皮瓣全部存活,其中1例因靜脈危象而進(jìn)行二次手術(shù)探查,及時(shí)清除血栓后順利成活。6例病例平均總手術(shù)時(shí)間為6.65小時(shí),其中平均皮瓣制備時(shí)間為65分鐘。術(shù)中發(fā)現(xiàn)穿支情況與術(shù)前手用多普勒檢查結(jié)果一致。皮瓣面積3.5cm*4cm)-(6.5cm*6cm),平均23.6cm2；血管蒂長(zhǎng)度7-11cm,平均8.75cm；術(shù)中發(fā)現(xiàn)穿支數(shù)目1～2支。穿支位置距離乆紋線中點(diǎn)的長(zhǎng)度為8.5～11cm,平均為9.75cm；距離小腿后正中線距離為0.1-2cm,平均距離為1.Ocm。 術(shù)后隨訪所有患者對(duì)術(shù)后舌體外形、咀嚼及吞咽功能滿意。皮瓣存活良好�；颊咝g(shù)后均出現(xiàn)發(fā)音不清癥狀,其中兩名患者癥狀較重。3月后復(fù)診發(fā)音不清癥狀均有所改善。皮瓣供區(qū)均采取直接縫合的方法關(guān)閉,創(chuàng)口Ⅰ期愈合,瘢痕較隱蔽,患者除出現(xiàn)局部皮膚輕度感覺異常外,無(wú)肢體運(yùn)動(dòng)受限等其他嚴(yán)重的術(shù)后并發(fā)癥。 結(jié)論： 游離腓腸內(nèi)側(cè)動(dòng)脈穿支皮瓣作為一種新興的穿支皮瓣正逐漸被引入到口腔頜面外科腫瘤術(shù)后缺損重建中。通過(guò)我科的實(shí)踐證明,游離腓腸內(nèi)側(cè)動(dòng)脈穿支皮瓣解剖結(jié)構(gòu)穩(wěn)定,皮瓣厚薄、質(zhì)地適宜,術(shù)后供區(qū)并發(fā)癥少,外形和語(yǔ)言功能恢復(fù)效果滿意,非常適用于中小型舌癌術(shù)后缺損修復(fù)。
[Abstract]:Objective:. To observe the clinical effect of free medial sural artery perforator flap in repairing the defect of small and medium tongue cancer and summarize the clinical experience. Methods:. From March 2013 to February 2014, 6 patients with tongue cancer were treated with free medial sural artery perforator flap to repair soft tissue defect. The perforating branch flap was made according to the size of defect during the operation, the size of the flap, the number and location of perforating vessels and the length of vascular pedicle were recorded, and the survival of the flap was observed after operation, and the healing of donor area and the recovery of tongue body function were recorded. Results:. All the skin flaps transplanted from 6 patients survived, and one patient underwent secondary surgical exploration because of venous crisis. The average total operative time of 6 cases was 6.65 hours after prompt removal of thrombus. The average preparation time of the flap was 65 minutes. The perforating branch was found to be consistent with the preoperative Doppler examination. The flap area was 3.5cm ~ (-1) 4 cm ~ (-1) ~ 6.5 cm ~ (-1) cm ~ (-6) cm ~ (-2), the average was 23.6cm ~ (2), the pedicle length was 7-11 cm (mean 8.75 cm), the number of perforating branches was 1 ~ (2) and the perforating branch was located. The distance from the midpoint of the striate to the midpoint of the stripe is 8.5 cm, with an average of 9.75 cm, and the distance from the median line of the calf to the posterior median line is 0.1-2 cm, with an average distance of 1.Ocm. All patients were followed up with satisfactory tongue body shape, masticatory and swallowing function. The flap survived well. The symptoms of two of the patients were more serious. After 3 months of follow-up, the symptoms of unclear pronunciation were improved. The donor area of the flap was closed by direct suture, the wound healed in the first stage, and the scar was concealed. There were no other severe postoperative complications such as limited limb movement. Conclusion:. As a new perforating branch flap, the free medial sural artery perforator flap is gradually introduced into the reconstruction of oral and maxillofacial tumor defects after operation. The anatomical structure of the free medial sural artery perforating branch flap is stable through our practice. The skin flap is suitable for the repair of small and medium-sized tongue cancer with less complications and satisfactory recovery of shape and language function.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.86

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