组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (2): 130-.

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颏下岛状皮瓣在下咽癌术后缺损修复中的临床应用——单中心经验分享

  

  • 出版日期:2023-04-01 发布日期:2023-05-09

Clinical application of submental island flap in repairing the postoperative defect of hypopharyngeal carcinoma: Single centre experience

  • Online:2023-04-01 Published:2023-05-09

摘要:

目的 回顾分析颏下岛状皮瓣在下咽癌术后缺损修复和功能重建中的应用,并结合新鲜灌注尸体解剖,从
皮瓣解剖设计、临床应用及修复效果进行单中心的经验总结。方法 本研究进行了 3 具新鲜灌注的成人尸体(6 侧
颏下岛状皮瓣区)的解剖分析,并分析了 13 例下咽癌切除术后一期颏下岛状皮瓣修复患者,均为男性,平均年龄 55 岁。
术后缺损部位包括梨状窝和下咽后壁。详细介绍颏下岛状皮瓣皮瓣制作的术中解剖要点及技术,血管蒂的保护及颌
下区淋巴结的处理。结果 所有 13 例患者皮瓣均一期愈合,下咽功能重建满意,供皮区的并发症主要是面神经下
颌缘支的一过性麻痹(3/13,23%),供皮区均一期局部拉拢缝合,无须植皮。结论 颏下岛状皮瓣是下咽术后缺损
的很好的修复选择之一。该皮瓣血管蒂恒定,成活率高。皮瓣获取与下咽癌手术在同一术区,切取方便,同时还可
以兼顾Ⅰ区淋巴结的处理。

关键词:

Abstract:

Objective To review the clinical application of submental island flap (SIF) in repairing the postoperative defect
of hypopharyngeal carcinoma, and discuss the anatomical design, clinical application and repair effects based on our single cen
ter experience combined with fresh perfusion cadavers study. Methods The anatomical analysis of 6 SIFs in 3 freshly perfused
adult cadavers was firstly carried out. Combined with clinical experience, 13 patients with submental island flap repair after
hypopharyngeal cancer resection were reviewed, all of them were male, with an average age of 55 years. Postoperative defects
included piriform fossa and posterior hypopharyngeal wall. The anatomical essentials and techniques of SIFs, the protection
of vascular pedicle and the management of submandibular lymph nodes were described in detail. Results All 13 SIFs were
healed primarily. The hypopharyngeal functions were satisfied. The main complication of the donor site was transient paralysis
of the marginal mandibular branch of the facial nerve (3/13, 23%). The donor site was primarily closed without skin grafting.
Conclusion SIF may be an appropriate option for repairing hypopharyngeal defects. The vascular pedicle of the flap is con
stant and the survival rate is high. The skin flap can be obtained in the same surgical area as the hypopharyngeal cancer surgery,
which is convenient to harvest, and it can also take into account the management of lymph nodes in Level Ⅰ.

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