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目的探讨自体游离组织瓣修复头颈部术后组织缺损的临床应用价值。方法收集2008年5月至2012年10月期间头颈科肿瘤手术治疗的病例共71例进行分组分析,其中修复组应用自体游离组织瓣修复重建头颈部组织缺损(33例),对照组未应用游离组织瓣修复(38例),总结游离组织瓣应用的经验及价值。结果 33例自体游离组织瓣中前臂皮瓣修复重建17例(舌缺损12例、口颊粘膜5例),腓骨骨皮瓣修复颌骨缺损9例,股前外侧皮瓣3例(口底2例、面部皮肤1例),空肠瓣修复颈段食管2例,足背皮瓣修复口颊粘膜1例,髂骨瓣修复下颌骨1例。其中2例部分坏死,其余31例均获成功。舌切除后应用前臂皮瓣修复的修复组发音清晰度和吞咽功能比对照组好。上下颌骨缺损的修复组面部颌骨外形好于对照组。结论不同自体组织瓣血管化应用头颈肿瘤手术后原发病灶缺损I期重建修复,不仅有助于肿瘤切除彻底,而且术后功能恢复较好。
Objective To investigate the clinical value of autologous free flap for repair of tissue defects after head and neck surgery. Methods A total of 71 cases of head and neck cancer surgeries were collected from May 2008 to October 2012. The patients in the repair group were treated with autologous free flap for the reconstruction of head and neck tissue defects (33 cases). The control group was not used Free tissue flap repair (38 cases), summarize the experience and value of the application of free tissue flap. Results The flap of forearm was reconstructed in 17 cases (12 cases of tongue defect and 5 cases of oral buccal mucosa) in 33 cases of autogenous tissue flap. 9 cases of jaw defect were repaired by peroneal bone flap and 3 cases of anterolateral skin flap 1 case of facial skin), jejunal flap in 2 cases of cervical esophagus, dorsal skin flap in 1 case of buccal mucosa and 1 case of ilium flap in the reconstruction of mandible. Two of them were partially necrotic, and the remaining 31 patients were successful. In the repair group with lingual resection forearm flap, articulation and swallowing function were better than those in control group. The maxillary and mandibular defect repair group facial jaw shape is better than the control group. CONCLUSION: The reconstruction of primary defect of primary lesion after head and neck surgery with vascularization of different autologous tissue flap will not only help the tumor resection completely, but also restore the function after operation.