游离肩胛区骨皮瓣在舌及口底及下颌骨联合缺损修复中应用.docVIP

游离肩胛区骨皮瓣在舌及口底及下颌骨联合缺损修复中应用[摘要]目的：介绍游离肩胛区骨皮瓣在舌、口底和下颌骨缺损修复中的临床实践。方法：应用肩胛区骨皮瓣游离移植修复因舌癌行扩大根治切除术后的舌、口底、下颌骨联合缺损病人2例，术中根据下颌骨、牙槽、口底和舌缺损的大小设计肩胛区骨皮瓣；术中顺向或逆向寻找血管蒂，掀起肩胛区骨皮瓣，游离移植于口内，吻合血管，固定肩胛骨瓣于颌骨缺损内，将皮瓣与口内缺损创缘缝合，覆盖牙槽、口底、再造舌。结果：骨皮瓣全部成活。患侧颌面形态和舌外形恢复满意。其中1例患者术后5天死亡，死因疑为消化道大出血。结论：肩胛区骨皮瓣具有血管恒定、切口隐蔽、对供区功能影响小、可供组织种类和组织量多、修复范围广等特点，是修复头颈部复合缺损的一种比较满意的方法。 [关键词]肩胛区骨皮瓣；舌缺损；下颌骨缺损；口底缺损 [中图分类号]R782 [文献标识码]A [文章编号]1008-6455（2009）03-0315-03 Scapular osteocutaneous free flap for complex tongue, oral floor and mandibula econstruction TANG Xin,MA Ting-ting,QIN Yong-ping,WU Di,ZHAO Zhen-min (The First Department of Plastic Surgery Hospital, Chinese Academic Medical Science and Peking Union Medical College,Beijing 100144, China) Abstract: Objective The purpose of this study is to introduce the clinic experience of using scapular osteocutaneous free flap for tongue, oral floor and mandibula reconstruction. Methods Scapular osteocutaneous free flap was used in 2 patients with tongue, oral floor and partial mandibula defect resulting from radical excision of carcinoma of tongue．According to the size of the defects, the osteocutaneous flaps with circle scapular vessels as the pedicle were designed and transferred into oral cavity by vastular anastomosis technique to reconstruct mandibula, oral floor and tongue. Results Both of the scapular osteocutaneous flaps were survived, although one patient was dead 5th day after operation maybe because of digestive canal hemorrhoea. The satisfactory result was achieved in another patient. Conclusion Scapular osteocutaneous flap showed many advantages：minor deformity of the donor site，stable blood supply，and given the amount and variability of tissue types available for harvest．It is excellent for through-and-through oromandibular defects, which require tissue for intraoral and external skin lining, as well as bone. Key words: scapular osteocutaneous free flap；tongue defect；mandibular defect；oral floor defect 外科手术是口腔颌面部肿瘤治疗的主要手段之一，但是手术切除造成的组织缺损、