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find Author "林建英" 3 results
  • Application of deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flaps in reconstruction of complex oromandibular defects

    Objective To evaluate the reliability and effectiveness of a deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flap (DCIA-IIOF) in reconstruction of complex oromandibular defect. Methods Between January 2010 and December 2015, DCIA-IIOFs were used to repair complex oromandibular defects in 11 patients. There were 8 males and 3 females, with an age of 27-75 years (median, 56 years). Original disease was lower gingival squamous cell carcinoma in 7 cases (T3N1M0 in 2 cases, T3N2M0 in 1 case, T4N0M0 in 2 cases, and T4N2M0 in 2 cases), osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma in 2 cases, central mandibular squamous cell carcinoma in 1 case (T4N0M0), and mandibular malignant fibrous histiocytoma in 1 case. The length of mandibular bone defects ranged from 7 to 10 cm (mean, 8 cm), and the area of the mucosal defects ranged from 5 cm×3 cm to 7 cm×4 cm. Preoperative ultrasonic identification of the DCIA and its ascending branch was routinely performed. The DCIA-IIOF was harvested by using an anterograde dissection technique, of which the iliac island was used for segmental mandibular defect repair and the musculofascial island for soft tissue and mucosal defect repair. Results All 11 cases were followed up 15-75 months (median, 37 months). All flaps survived after operation, without necrosis of both iliac island and oblique internal musculofascial island. One patient had a mild submandibular infection which healed after wound drainage and intravenous antibiotics. At 1 month after operation, the color and texture of the musculofascial island were similar to oral mucosa without contracture, and the occluding relation was good for all patients. At 6 months after operation, the mouth opening hardly improved in 2 patients who had osteoradionecrosis; 1 patient who underwent postoperative radiotherapy had restriction of mouth opening; the remaining 8 patients had normal month opening and normal diet. Three patients died of cancer recurrence, 2 patients died of other diseases (encephalorrhagia in 1 case and myocardial infarction in 1 case), and the others survived without recurrence during follow-up. No patient developed abdominal hernia during follow-up. Conclusion DCIA-IIOF is a reliable flap in reconstruction of complex oromandibular defects. The occluding relation after operation is good and the mucosal lining is soft. This technique provides an effective option for moderate complex oromandibular defects repair.

    Release date:2018-12-04 03:41 Export PDF Favorites Scan
  • 股前外侧皮瓣在口腔肿瘤术后缺损修复中的初步应用

    目的 总结股前外侧皮瓣(anterolateral thigh flap,ALT)修复口腔肿瘤切除术后缺损的临床效果。方法 2005 年6 月- 2007 年6 月,采用ALT 修复14 例口腔癌术后缺损。男8 例,女6 例;年龄21 ~ 69 岁。下牙龈鳞癌3 例,侧口底鳞癌3 例,上腭或上牙龈鳞癌3 例,上腭黏液表皮样癌不全术后1 例,舌根鳞癌4 例。病程1 ~ 5 个月。分别采用单纯手术6 例,诱导化疗、手术联合放疗5 例,手术联合放疗3 例。肿瘤切除后缺损范围6 cm × 4 cm ~ 12 cm × 9 cm,皮瓣切取范围7 cm × 5 cm ~ 14 cm × 10 cm。供区直接缝合。术中1 例发现穿支血管缺如,1 例损伤穿支血管改用前臂皮瓣。 结果 术后14 例皮瓣均成活,供、受区切口均Ⅰ期愈合。14 例均获随访,随访时间5 ~ 29 个月。皮瓣外形均满意,吞咽、发音等功能恢复良好。1 例上腭癌术后6 个月复发,放疗后至今带瘤生存8 个月;1 例上腭癌术后5 个月出现第3 原发癌,化疗后生存8 个月;其余12 例无瘤生存。 结论 ALT 手术成功率较高,组织量丰富,适用于较大缺损修复,对供区影响小,修复后受区功能良好,可安全地用于口腔软组织缺损修复。

    Release date:2016-09-01 09:17 Export PDF Favorites Scan
  • 组织瓣移植修复头颈癌术后缺损

    目的 探讨游离组织瓣和带蒂组织瓣移植一期修复局部晚期头颈癌术后缺损的适应证和技巧。方法 2005年3月~12月采用自体组织移植一期修复头颈癌术后缺损25例,年龄14~78岁;其中舌癌7例(T3N1M0、T3N2M0、T3N0M0各2例,T4N2M0 1例);颊黏膜癌4例(T3N2M0 1例,T4N0M0 2例,放疗后未控1例);下牙龈癌3例(T4N1M0 2例,术后复发侵犯皮肤1例);口底癌2例(T4N3M0,T4N0M0各1例);硬腭癌1例(T4N0M0);硬腭癌术后复发1例;软腭癌放疗后未控1例;下咽放疗后未控2例;鼻咽癌放疗后颈淋巴结复发侵犯皮肤2例;颞部皮肤癌1例;喉癌术后复发1例。采用游离组织瓣12例,其中桡侧前臂皮瓣8例,空肠瓣2例,髂骨瓣1例,股前外侧皮瓣1例;带蒂组织瓣13例,其中胸大肌肌皮瓣4例,斜方肌肌皮瓣2例,舌骨下肌肌皮瓣7例。术后观察组织瓣成活率、并发症和近期疗效。 结果 术后1例空肠瓣坏死,1例舌骨下肌肌皮瓣部分坏死,其余组织瓣全部成活,伤口Ⅰ期愈合。全部患者随访2~10个月,原发灶未控或复发5例,其中3例死亡;2例带瘤生存,颈淋巴结复发1例,挽救手术后生存至今;无瘤生存20例。外形满意20例,基本满意4例,不满意1例。吞咽功能满意22例,基本满意2例,不能吞咽1。22例术后发音满意,3例喉全切术不能发音。 结论 组织瓣移植扩大手术适应证,为局部晚期或者放疗后复发/未控的头颈癌患者治疗提供机会;游离组织瓣和带蒂组织瓣移植具有较高成功率,应根据患者一般情况和缺损类型选择合适的修复方法;保证血供和静脉回流是组织移植成功的关键。

    Release date:2016-09-01 09:22 Export PDF Favorites Scan
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