腹壁下动脉穿支皮瓣在全舌癌缺损修复中的应用效果评价

doi:10.19438/j.cjoms.2019.06.014

中国口腔颌面外科杂志 ›› 2019, Vol. 17 ›› Issue (6): 550-553.doi: 10.19438/j.cjoms.2019.06.014

腹壁下动脉穿支皮瓣在全舌癌缺损修复中的应用效果评价

李军^1,*, 黄晶^2,*, 高炳菊¹, 邱宇¹, 林阳¹, 阮召伟³, 叶卓¹, 林李嵩¹

1.福建医科大学附属第一医院口腔颌面外科,福建医科大学面部整复与重建研究室,福建福州 350005;
2.福建医科大学转化医学研究院,福建福州 350122;
3.福建医科大学附属宁德市医院口腔科,福建宁德 352100

收稿日期:2019-03-12 出版日期:2019-11-20 发布日期:2019-12-16
通讯作者: 林李嵩,E-mail：dr-lls@163.com
作者简介:李军（1986-）,男,住院医师,E-mail：1986lijun1234@163.com;黄晶（1990-）,女,硕士,E-mail：jingjing1990@yeah.net。*并列第一作者
基金资助:
省卫生健康委医学创新课题（2017-cx-27）; 福建省教育厅中青年教师教育科研项目（JAT170215）

Application of deep inferior epigastric perforator flaps (DIEP) in total tongue reconstruction after resection of tongue carcinoma

LI Jun¹, HUANG Jing², GAO Bing-ju¹, QIU Yu¹, LIN Yang¹, RUAN Zhao-wei³, YE Zhuo¹, LIN Li-song¹

1. Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Laboratory of Facial Plastic and Reconstructive Surgery. Fuzhou 350005;
2. Institute of Translational Medicine, Fujian Medical University. Fuzhou 350122;
3. Department of Stomatology, Ningde City Hospital Affiliated to Fujian Medical University. Ningde 352100, Fujian Province, China

Received:2019-03-12 Online:2019-11-20 Published:2019-12-16

摘要/Abstract

摘要： 目的: 评价游离腹壁下动脉穿支皮瓣（deep inferior epigastric perforator,DIEP）用于舌癌术后全舌缺损修复的效果。方法: 2018年1月—2018年7月应用游离DIEP修复13例舌癌患者,手术缺损部位均为全舌或近全舌缺损。术中将腹壁下动脉与甲状腺上动脉或面动脉吻合,伴行静脉与颈外静脉或颈内静脉属支吻合。结果: l3例DIEP皮瓣均修复成功,皮瓣外观满意。术后随访舌形态良好,功能满意。供区直接闭合,其中1例患者皮瓣供区出现感染,经换药后愈合。所有腹部伤口均为线性瘢痕,腹直肌功能未受明显影响,未发现腹壁疝和腹壁隆起等手术并发症。结论: 腹壁下动脉穿支皮瓣组织量丰富、血供可靠、质地柔软,再造舌外形及功能良好,且供区保留了腹直肌和前鞘,损伤小,将供区并发症降到最低限度,是舌癌术后全舌缺损修复新的可靠技术。

关键词: 全舌缺损, 腹壁下动脉穿支皮瓣, 修复与重建

Abstract: PURPOSE: To evaluate the value of deep inferior epigastric perforator flap in repairing postoperative defects after total tongue resection due to cancer. METHODS: From January 2018 to July 2018, deep inferior epigastric perforator flap was used to repair 13 total tongue defect after tongue carcinoma resection. All the deep inferior epigastric arteries were anastomosed with superior thyroid anteries or facial arteries, while the venae eomitans were anastomosed with the external jugular venae or the branches of internal jugular venae. RESULTS: Thirteen DIEP flaps survived uneventfully, the shape of the flaps in reconstruction of total tongue was satisfactory, the function was also satisfying. The donor area was closed directly. Of 13 patients, only one had abdominal wound infection, which was cured by dressing change. All abdominal wounds were healed leaving linear scar, the function of rectus abdominis was not affected obviously, and no complications such as abdominal wall hernia and abdominal wall protuberance were found. CONCLUSIONS: DIEP flap is rich in tissue, reliable in blood supply, good in shape and function. The complications of donor area are minimized. It is a new and reliable technique for reconstruction of total tongue defect.

Key words: Total tongue defect, Inferior abdominal artery perforator flap, Repair and reconstruction

中图分类号:

R782.2

李军, 黄晶, 高炳菊, 邱宇, 林阳, 阮召伟, 叶卓, 林李嵩. 腹壁下动脉穿支皮瓣在全舌癌缺损修复中的应用效果评价[J]. 中国口腔颌面外科杂志, 2019, 17(6): 550-553.

LI Jun, HUANG Jing, GAO Bing-ju, QIU Yu, LIN Yang, RUAN Zhao-wei, YE Zhuo, LIN Li-song. Application of deep inferior epigastric perforator flaps (DIEP) in total tongue reconstruction after resection of tongue carcinoma[J]. China J Oral Maxillofac Surg, 2019, 17(6): 550-553.

参考文献

[1] 邱宇, 林李嵩, 施斌, 等. 分叶股前外侧皮瓣在口腔颌面部缺损中的修复应用[J].福建医科大学学报, 2015, 49(5): 326-329.
[2] Wei FC, Jain V, Celik N, et al.Have we found an idea soft-tissue flap? An experience with 672 anterolateral thigh flaps[J]. Plast Reconstr Surg, 2002, 109(7): 2227-2230.
[3] Fujino T.Contribution of the axial and perforator vasculature to circulation in flaps[J]. Plast Reconstr Surg, 1967, 39(2): 125-137.
[4] Chen HC, Tang YB.Anterolateral thigh flap: an ideal soft tissue flap[J]. Clin Plast Surg, 2003, 30(3): 383-401.
[5] 白植宝, 黄磊, 王新. 应用游离股前外侧皮瓣重建舌癌术后组织缺损[J]. 口腔颌面外科杂志, 2014, 24(5): 352-355.
[6] Lipa JE, Novak CB, Binhammer PA.Patient-reported donor-site morbidity following anterolateral thigh free flaps[J].J Reconstr Microsurg, 2005, 21(6): 365-370.
[7] Addison PD, Lannon D, Neligan PC, et a1. Compartment syndrome after closure of the anterolateral thigh flap donor site: a report of two cases[J]. Ann Plast Surg, 2008, 60(6): 635-638.
[8] Odili J, Wilson E, Chana JS.Muscle herniation: a complication at the anterolateral thigh perforator flap donor site[J].J Plast Reconstr Aesthet Surg, 2009, 62(11): 1530-1533.
[9] 常树森, 何春念, 金文虎, 等. 股前外侧皮瓣的供区并发症[J].中华显微外科杂志, 2018, 41(1): 101-104.
[10] Chen YC, Scaglioni MF, Carrillo Jimenez LE, et al.Suprafascial anterolateral thigh flap harvest: a better way to minimize donor-site morbidity in head and neck reconstruction[J]. Plast Reconstr Surg, 2016, 138(3): 689-698.
[11] Urken ML, Weinberg H, Buchbinder D, et al.Microvascular free flaps in head and neck reconstruction. Report of 200 cases and review of complications[J].Arch Otolaryngol Head Neck Surg, 1994, 120(6): 633-640.
[12] Jones NF, Sekhar LN, Schramm VL.Free rectus abdominis muscle flap reconstruction of the middle and posterior cranial base[J]. Plast Reconstr Surg, 1986, 78(4): 471-479.
[13] Taylor GI, Corlett R, Boyd JB.The extended deep inferior epigastric flap: a clinical technique[J]. Plast Reconstr Surg, 1983, 72(6): 75l-765.
[14] Koshima I, Soeda S.Inferior epigastric artery skin flap without rectus abdominis muscle[J]. Br J Plast Surg, 1989, 42(6): 645-648.
[15] Allen PJ,Treece P.Deep inferior epigastric perforator flap for breast reconstruction[J]. Ann Plast Surg, 1994, 32(1): 32-38.
[16] Beausang ES, McKay D, Brown DH, et al. Deepinferior epigastric artery perforator flaps in head and neck reconstruction[J]. Ann Plast Surg, 2003, 51(6): 561-563.
[17] Zhang B, Li DZ, Xu ZG, et a1. Deep inferior epigastrie artery perforator free flaps in head and neck reconstruction[J]. Oral Oncol, 2009, 45(2): 116-120.
[18] 陈世新, 丁茂超, 崔怀瑞, 等. 腹壁下动脉穿支皮瓣的3D可视化研究[J]. 解剖学报, 2011, 42(2): 269-273.
[19] 孙坚. 游离腹壁下深动脉穿支皮瓣修复头颈肿瘤术后缺损(评述)[J]. 中国口腔颌面外科杂志, 2007, 5(5): 350-351.
[20] Yun IS, Lee DW, Lee WJ, et al.Correlation of neotongue volume changes with functional outcomes after long-term follow-up of total glossectomy[J]. J Craniofac Surg, 2010, 21(1): 111-116.
[21] Sakamoto Y, Takahara T, Ota Y, et al.MRI analysis of chronological changes in free-flap volume in head and neck reconstruction by volumetry[J]. Tokai J Exp Clin Med, 2014, 39(1): 44-50.
[22] Hsiao HT, Leu YS, Lin CC.Primary closure versus radial forearm flap reconstruction after hemiglossectomy: functional assessment of swallowing and speech[J]. Ann Plast Surg, 2002, 49(6): 612-616.
[23] Engel H, Huang JJ, Lin CY, et al.A strategic approach for tongue reconstruction to achieve predictable and improved functional and esthetic outcomes[J]. Plast Reconstr Surg, 2010, 126(6): 1967-1977.
[24] Yoshioka F, Ozawa S, Sumita YI, et al.The pattern of tongue pressure against the palate during articulating glossal sounds in normal subjects and glossectomy patients[J]. J Med Dent Sci, 2004, 51(1): 19-25.

腹壁下动脉穿支皮瓣在全舌癌缺损修复中的应用效果评价

Application of deep inferior epigastric perforator flaps (DIEP) in total tongue reconstruction after resection of tongue carcinoma

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	胡潇丹, 徐豪越, 李晓, 卜令学, 贾暮云, 袁荣涛, 庞宝兴. 超声刀在辅助制备游离腓骨肌皮瓣中的临床应用[J]. 中国口腔颌面外科杂志, 2023, 21(2): 152-157.
[2]	葛卫文, 祁磊, 王昀, 张雷. 改良鼻旁植骨减少Le Fort I型截骨术后上颌骨垂直向复发的探讨[J]. 中国口腔颌面外科杂志, 2023, 21(2): 163-167.
[3]	陈伟良. 延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损[J]. 中国口腔颌面外科杂志, 2023, 21(1): 1-10.
[4]	葛良玉, 季莉, 王浩然, 李志萍, 顾倩平, 孟箭. 适形前臂桡侧皮瓣修复面颊部软组织缺损的效果评价[J]. 中国口腔颌面外科杂志, 2023, 21(1): 24-28.
[5]	王守鹏, 孟箭, 张雷. 上颌骨Le Fort Ⅰ型截骨术后上颌窦炎的研究现状[J]. 中国口腔颌面外科杂志, 2023, 21(1): 75-80.
[6]	张森林, 魏斌, 梁彤欣. 逆行Yu瓣修复上唇全厚缺损：1例报告及文献复习[J]. 中国口腔颌面外科杂志, 2022, 20(6): 618-620.
[7]	陈一铭, Ahmed, 季彤, 任振虎. 吲哚箐绿荧光显影在股前外侧皮瓣术中穿支示踪、选择的可行性及效果评价[J]. 中国口腔颌面外科杂志, 2022, 20(4): 396-400.
[8]	陶乐然, 张容斌, 林郁欣, 凌宗翔, 程梦佳, 于洪波. 深度学习在牙颌面畸形诊疗中的应用及研究进展[J]. 中国口腔颌面外科杂志, 2022, 20(4): 405-409.
[9]	刘冰, 何悦, 彭歆, 孙长伏, 韩正学, 吴煜农, 彭利伟, 赵熠, 陶谦, 韩新光, 李劲松, 苏彤, 李波, 张雷, 胡砚平, 陈传俊, 李一, 李铁军, 赵怡芳. 牙源性角化囊肿诊疗中国专家共识[J]. 中国口腔颌面外科杂志, 2022, 20(3): 209-218.
[10]	薛桃, 刘锐, 蔡欣云, 张永红, 张蕾蕾, 董金龙. 下颌先天性颗粒细胞牙龈瘤1例报告[J]. 中国口腔颌面外科杂志, 2022, 20(2): 206-208.
[11]	史伟红, 刘严, 阿曼妮萨罕·加帕尔, 阿依达娜·乌拉尔别克, 贺琦, 凌彬. 3D打印定位导板在辅助制备股前外侧穿支皮瓣中的临床应用[J]. 中国口腔颌面外科杂志, 2022, 20(1): 52-57.
[12]	陈佳怡, 孙仪庭, 刘加强. 牙槽骨牵引成骨治疗先天性双侧重度牙槽突裂1例报告[J]. 中国口腔颌面外科杂志, 2022, 20(1): 101-104.
[13]	王佳怡, 施巍, 胡蓉, 李静洁, 姜虹. 三维CT重建在肥胖OSAHS患者与正常人群上气道比较中的应用[J]. 中国口腔颌面外科杂志, 2021, 19(6): 549-552.
[14]	陈传俊, 陈伟良, 孙长伏, 何悦, 蒋灿华, 彭歆, 尚政军, 韩正学, 李劲松, 侯劲松, 林李嵩, 韩新光, 魏建华, 王志勇, 吴煜农, 郑家伟, 李龙江, 王慧明, 李祖兵, 郭传瑸, 杨驰, 石冰, 张志愿. 颏下岛状瓣修复口腔颌面部缺损专家共识[J]. 中国口腔颌面外科杂志, 2021, 19(5): 385-391.
[15]	赵涵江, 王泽莹, 林丹, 沈国芳. 纤维蛋白凝胶对上颌扩弓成骨矿化的影响[J]. 中国口腔颌面外科杂志, 2021, 19(5): 397-404.