改良橈側(cè)前臂游離皮瓣（MRFFF）在口腔頜面部惡性腫瘤切除缺損即刻修復中的應用
發(fā)布時間：2018-11-11 19:34
【摘要】：目的:介紹眼鏡式游離皮瓣(Glasses-shaped flap)一種改良的橈側(cè)前臂游離皮瓣(Modified radial forearm free flap,MRFFF)的技術要點,并通過比較傳統(tǒng)橈側(cè)前臂游離皮瓣(Traditional radial forearm free flap,TRFFF)和改良橈側(cè)前臂游離皮瓣在口腔頜面部惡性腫瘤切除缺損即刻修復及功能重建的臨床應用,探討眼鏡式游離皮瓣的適應癥、可靠性、優(yōu)點和技術要點。方法:收集出院日期在2016年1月1日至2016年12月31日于浙江大學醫(yī)學院附屬第二醫(yī)院濱江院區(qū)口腔領面外科行" 口腔頜面部惡性腫瘤擴大切除術"并同期應用橈側(cè)前臂游離皮瓣修復缺損的18例病例相關資料并作隨訪,1例失訪。其中5例應用傳統(tǒng)橈側(cè)前臂游離皮瓣修復缺損,其余13例均應用改良橈側(cè)前臂游離皮瓣。比較兩組病例中皮瓣存活率、供區(qū)形態(tài)和功能、受區(qū)形態(tài)和功能、患者滿意度等。結(jié)果:(1)MRFFF組皮島總大小為4cm*3.5cm至6cm*6cm,均保留頭靜脈于供區(qū),橈動脈血管蒂長度為8cm至12cm,均長為9.4cm;TRFFF組皮瓣大小為4cm*5cm至6.5cm*7cm,皮瓣均包括橈動靜脈和頭靜脈,其中橈動脈血管蒂長度從10cm至14cm,均長為12.8cm。(2)MRFFF組供區(qū)均實現(xiàn)潛行分離后直接拉攏縫合關閉供區(qū)缺損,TRFFF組供區(qū)均采用了游離皮片移植關閉缺損。所有病例的供區(qū)縫合處均愈合良好,MRFFF組術后未見創(chuàng)緣裂開,而TRFFF組移植皮片均存活,未見明顯感染壞死。(3)MRFFF組均采用橈動脈和2條橈靜脈為吻合血管,分別與面動脈(或者甲狀腺上動脈)和面總靜脈(或其屬支)及頸外靜脈吻合。TRFFF組均采用橈動脈和頭靜脈為吻合血管,分別與面動脈(或甲狀腺上動脈)和面總靜脈(或其屬支)或頸外靜脈吻合。MRFFF組皮瓣移植后存活率為100%(13/13),TRFFF組皮瓣移植后存活率為80%(4/5),其中失敗的1例TRFFF同時伴重建鈦板排異情況。(4)術后隨訪顯示,MRFFF組和TRFFF組術后患者生活質(zhì)量均較好。兩組患者對供區(qū)外觀滿意度均高。兩組均有病例出現(xiàn)術后供區(qū)局部麻木情況(術后3月以上仍舊麻木):MRFFF組:前臂麻木感4例(4/12),大拇指及虎口處麻木4例(4/12);TRFFF組前臂術區(qū)麻木2例(2/5),大拇指及虎口處麻木4例(4/5)。所有17例隨訪的前臂游離皮瓣患者術后手腕及手指運動功能受損情況均未達到影響日常生活程度。結(jié)論:眼鏡式游離皮瓣可以有效修復最大可達6cm*6cm的口腔頜面部軟組織缺損。該皮瓣采用橈動脈及兩條伴行靜脈為吻合血管,皮瓣存活率達100%(13/13)。相較于TRFFF,MRFFF主要具有以下優(yōu)點:(1)實現(xiàn)供區(qū)直接拉攏縫合,避免了游離皮片移植;(2)由于不需要頭靜脈作血管吻合,皮島完全設計在前臂掌側(cè),相對隱蔽,提高了術后美觀度;(3)減少了對橈神經(jīng)淺支和前臂外側(cè)皮神經(jīng)損傷的風險,從而降低了感覺功能損害。
[Abstract]:Objective: to introduce the technical essentials of a modified radial forearm free flap (Modified radial forearm free flap,MRFFF) of the spectacle free forearm flap (Glasses-shaped flap), and to compare (Traditional radial forearm free flap, with the traditional radial forearm free flap. TRFFF) and modified radial forearm free flap were used in immediate repair and functional reconstruction of malignant tumor in oral and maxillofacial region. The indications, reliability, advantages and technical points of spectacle free flap were discussed. Methods: extensive excision of oral and maxillofacial malignant tumors was performed at Binjiang Hospital, second affiliated Hospital, School of Medicine, Zhejiang University from January 1, 2016 to December 31, 2016. The data of 18 cases of radial forearm free flap repair defect were followed up. One case lost the visit. The defect was repaired by traditional radial forearm free flap in 5 cases and modified radial forearm free flap in 13 cases. The flap survival rate, donor area morphology and function, recipient area morphology and function, patient satisfaction were compared between the two groups. Results: (1) in MRFFF group, the total size of skin island was from 6 cm to 6 cm, and the length of pedicle of radial artery was from 8cm to 12 cm, and the length of pedicle of radial artery was 9.4 cm. In TRFFF group, the size of the flap ranged from 6.5 cm to 6.5 cm ~ 7 cm. The flap included radial arteriovenous and cephalic vein, and the pedicle length of radial artery was from 10cm to 14 cm. The average length of donor area was 12.8 cm 路(2) the donor area of MRFFF group was closed and closed directly after subsurface separation, and free skin graft was used to close the defect in TRFFF group. In all cases, the suture site of donor area healed well, and there was no laceration in the MRFFF group, while in the TRFFF group, the grafts survived without obvious infection and necrosis. (3) the radial artery and two radial veins were used as anastomotic vessels in the MRFFF group. They were anastomosed with facial artery (or superior thyroid artery), common facial vein (or its branches) and external jugular vein respectively. Radial artery and cephalic vein were used as anastomoses in TRFFF group. Anastomosis with the facial artery (or superior thyroid artery) and the common facial vein (or its branches) or external jugular vein respectively. The survival rate of the flap in the MRFFF group was 100% (80% (4 / 5) in 13 / 13), TRFFF group). (4) the postoperative follow-up showed that the quality of life of the patients in the MRFFF group and TRFFF group was better than that in the TRFFF group. The patients in both groups were satisfied with the appearance of donor area. There were local numbness of donor area in both groups (): MRFFF group: 4 cases (4 / 12) of forearm numbness, 4 cases (4 / 12) of thumb and tiger mouth numbness); In TRFFF group, there were 2 cases of forearm numbness (2 / 5), 4 cases of thumb and tiger mouth numbness (4 / 5). All 17 cases of forearm free flap were not affected by the degree of daily life. Conclusion: the spectacle free flap can effectively repair the oral and maxillofacial soft tissue defects up to 6cm*6cm. The flap was anastomosed with radial artery and two accompanying veins. The survival rate of the flap was 100% (13 / 13). Compared with TRFFF,MRFFF, it has the following advantages: (1) realize direct suture of donor area and avoid free skin graft; (2) because there is no need for vascular anastomosis of the cephalic vein, the skin island is completely designed on the palmar side of the forearm, which is relatively hidden, and improves the aesthetic degree after operation. (3) the risk of injury to superficial branch of radial nerve and lateral cutaneous nerve of forearm was reduced, and the damage of sensory function was reduced.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.8
，
本文編號：2325911
[Abstract]:Objective: to introduce the technical essentials of a modified radial forearm free flap (Modified radial forearm free flap,MRFFF) of the spectacle free forearm flap (Glasses-shaped flap), and to compare (Traditional radial forearm free flap, with the traditional radial forearm free flap. TRFFF) and modified radial forearm free flap were used in immediate repair and functional reconstruction of malignant tumor in oral and maxillofacial region. The indications, reliability, advantages and technical points of spectacle free flap were discussed. Methods: extensive excision of oral and maxillofacial malignant tumors was performed at Binjiang Hospital, second affiliated Hospital, School of Medicine, Zhejiang University from January 1, 2016 to December 31, 2016. The data of 18 cases of radial forearm free flap repair defect were followed up. One case lost the visit. The defect was repaired by traditional radial forearm free flap in 5 cases and modified radial forearm free flap in 13 cases. The flap survival rate, donor area morphology and function, recipient area morphology and function, patient satisfaction were compared between the two groups. Results: (1) in MRFFF group, the total size of skin island was from 6 cm to 6 cm, and the length of pedicle of radial artery was from 8cm to 12 cm, and the length of pedicle of radial artery was 9.4 cm. In TRFFF group, the size of the flap ranged from 6.5 cm to 6.5 cm ~ 7 cm. The flap included radial arteriovenous and cephalic vein, and the pedicle length of radial artery was from 10cm to 14 cm. The average length of donor area was 12.8 cm 路(2) the donor area of MRFFF group was closed and closed directly after subsurface separation, and free skin graft was used to close the defect in TRFFF group. In all cases, the suture site of donor area healed well, and there was no laceration in the MRFFF group, while in the TRFFF group, the grafts survived without obvious infection and necrosis. (3) the radial artery and two radial veins were used as anastomotic vessels in the MRFFF group. They were anastomosed with facial artery (or superior thyroid artery), common facial vein (or its branches) and external jugular vein respectively. Radial artery and cephalic vein were used as anastomoses in TRFFF group. Anastomosis with the facial artery (or superior thyroid artery) and the common facial vein (or its branches) or external jugular vein respectively. The survival rate of the flap in the MRFFF group was 100% (80% (4 / 5) in 13 / 13), TRFFF group). (4) the postoperative follow-up showed that the quality of life of the patients in the MRFFF group and TRFFF group was better than that in the TRFFF group. The patients in both groups were satisfied with the appearance of donor area. There were local numbness of donor area in both groups (): MRFFF group: 4 cases (4 / 12) of forearm numbness, 4 cases (4 / 12) of thumb and tiger mouth numbness); In TRFFF group, there were 2 cases of forearm numbness (2 / 5), 4 cases of thumb and tiger mouth numbness (4 / 5). All 17 cases of forearm free flap were not affected by the degree of daily life. Conclusion: the spectacle free flap can effectively repair the oral and maxillofacial soft tissue defects up to 6cm*6cm. The flap was anastomosed with radial artery and two accompanying veins. The survival rate of the flap was 100% (13 / 13). Compared with TRFFF,MRFFF, it has the following advantages: (1) realize direct suture of donor area and avoid free skin graft; (2) because there is no need for vascular anastomosis of the cephalic vein, the skin island is completely designed on the palmar side of the forearm, which is relatively hidden, and improves the aesthetic degree after operation. (3) the risk of injury to superficial branch of radial nerve and lateral cutaneous nerve of forearm was reduced, and the damage of sensory function was reduced.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.8
，
本文編號：2325911
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