摘要目的 评价应用小腿后外侧腓动脉双叶穿支游离皮瓣移植修复口腔颌面部恶性肿瘤术后面颊部洞穿性缺损的临床效果.方法 2016年5月至2018年5月,对9例因口腔颌面部恶性肿瘤根治而导致一侧面部组织洞穿性缺损的患者术中采用小腿后外侧腓动脉双叶穿支游离皮瓣修复重建,其中颊黏膜鳞状细胞癌4例,上颌骨骨肉瘤2例,上颌窦鳞状细胞癌1例,腮腺导管癌2例.术中双叶穿支皮瓣切取的面积大叶为7.0cm×8.0 cm～6.0 cm×7.0 cm,小叶为4.5 cm×4.5 cm～4.0 cm×4.0 cm.口内分别修复上腭或颊部的口腔黏膜缺损,口外修复面颊部软组织缺损.术后1.0～1.5个月采用放射治疗.术后门诊随访评价患者的外形、开口度、吞咽功能、语言功能及愈后.结果 术后随访3～18个月.9例患者小腿后外侧腓动脉双叶穿支游离皮瓣均成活,供区均直接拉拢缝合,术后供、受区切口均一期愈合.术后放射治疗对修复的穿支皮瓣无损害.术后6个月,患者张口度、吞咽功能、语言功能基本恢复正常,面部外形满意,随访期内9例患者均无肿瘤复发转移.结论 小腿后外侧腓动脉双叶穿支游离皮瓣穿支血管恒定,设计灵活,组织量丰富,修复方式和幅度多变,是修复口腔颌面洞穿性缺损较为理想的穿支皮瓣.

abstractsObjective To evaluate the effect of double-leaf perforator free flap pedicled with posterolateral calf peroneal artery on repairing facial through-and-through defect after oral cancer oblation.Methods Nine patients with facial through-and-through defects after oblation of oral and maxillofacial malignancies,including 4 cases of buccal mucosa carcinoma,2 cases of maxilla osteosarcoma,1 case of carcinoma of the maxillary sinus and 2 cases of parotid duct carcinoma,were recruited from May,2016 to May,2018.The flap was used to repair the facial defect of recruited patients.The area of the bigger leaf of bilobed perforator flap was 7.0 cm×8.0 cm-6.0 cm×7.0 cm and the small leaf was 4.5 cm×4.5 cm-4.0 cm×4.0 cm,respectively.The intraoral and facial defects needed to be reconstructed contained the oral mucosal of the upper palate,the skin,subcutaneous tissue and mucosa of the cheek.The radiotherapy was performed 1.0-1.5 months after the operation.The prognosis including appearance,mouth opening,and the functions of deglutition,and language were assessed.Results Through 3-18 months outpatient followed-up,all 9 cases of transplanted flaps survived well and the incisions of the donor and recipient areas healed by first intention.The patients were satisfied with the facial appearance,mouth opening,and the functions of deglutition and language at the 6 months follow-up.The radiotherapy had no damage on the survival of the bilobed perforator flap.There was no recurrence or metastasis in follow-up.Conclusion The double-leaf perforator free flap pedicled with posterolateral calf peroneal artery is an ideal free tissue for repairing the facial perforating defect after oral cancer oblation because of its constant blood vessel,abundant tissues,flexible design and operating methods.