【作者】 黄江；

【导师】 吴汉江；

【作者基本信息】 中南大学 ， 口腔临床医学， 2011， 硕士

【摘要】 目的评估因口腔癌联合根治软组织缺损行游离股前外侧肌皮瓣修复,术后皮瓣供区并发症及功能恢复情况,为合理选择和改良供区手术方案,减少供区并发症提供参考。方法选取2011年2月1日至5月1日在中南大学湘雅二医院口腔颌面外科门诊及住院部所有复查的病人中因口腔癌联合根治软组织缺损,并于Ⅰ期行游离股前外侧肌皮瓣修复手术的患者61例。查阅所有患者入院期间的临床病历资料,排除既往史有中枢性疾病及骨关节炎等影响下肢运动的病例。实际纳入统计的为60例。在同一名临床经验丰富的康复科医生的协助下,通过评估表测量加问卷调查(见附录1)的方式描述性分析患者术后供区功能恢复情况及相关并发症。采用SPSS17.0对数据进行统计学分析。结果所有患者均完成评估表及问卷调查表,随访时间32天-1287天,平均319天。男性52例,女性8例。年龄25岁-68岁,平均(51.75±10.29)岁。皮瓣制备面积2cm×4cm-6cm×22cm,肌肉切取面积2cm×2cm-6cm×7cm。皮瓣成功59例,成功率为98.3%,1例皮瓣因术后出现静脉危象完全坏死。供区直接缝合58例,供区植皮2例。近期供区并发症包括：供区伤口感染6例,占病例总数10%,血肿1例,伤口裂开1例。无肌肉坏死及植皮坏死的病例。远期并发症包括：患侧股四头肌肌力减弱的7例。出现供区皮肤感觉异常的50例(约83.3%)。其中供区外上份感觉减退的10例,外中份感觉减退的39例,感觉消失1例,外下份感觉减退40例,感觉消失5例,无感觉过敏及倒错的病例。2例出现供区寒冷耐受不良。3例患者认为供区疤痕严重影响外观。无供区髋膝关节活动受限,肌肉疝出的病例。结论1、制备游离股前外侧肌皮瓣术后患者供区的感觉障碍分布于股前外侧区,主要集中在股前外侧的中下区,其主要原因与损伤股外侧皮神经有关。2、制备游离股前外侧肌皮瓣的面积越大,皮瓣位置越靠近股外侧上份,股前外侧区出现感觉障碍的概率越大。3、制备游离股前外侧肌皮瓣的肌瓣大小对术后肌力影响较小。4、游离股前外侧肌皮瓣供区部位隐蔽,患者易于接受。更多还原

【Abstract】 ObjectiveTo investigate the donor-site complications of the free anterolateral myocutaneous flap which used to repair the soft tissue defects caused by the oral carcinoma operation. And make an assessment for the functional recovery of the donor-site. Provide clinical guidance on choosing a better method to make free anterolateral thigh flap in order to reduce the complications in donor-site.Methods61 patients from February 1st,2011 to May 1st,2011 who have reexamination in the second XiangYa Hospital,Central South University were selected. They all have suffered the resection of oral and maxillofacial malignant and inⅠphase reconstruction with free anterolateral myocutaneous flap. Consult their medical records, patients with preoperative donor-site morbidity from cerebral dysfunction or osteoarthritis of the lower extremities were excluded. So, we actually selected 60 patients. With the help of a same Rehabilitation practitioner who have rich clinical experience, several variables were assessed in the intraoperative and postoperative period, and a questionnaire was given to patients(Appendix 1). The data were analysed by descriptive analysis and T test using SPSS 17.0 software package.ResultsAll patients finished the evaluation table and questionnaire. All patients were followed up for 32-1287days (mean:319 days). There were 52 males and 8 females aged 25-68 years old (mean:51.75±10.29 years old). The free flaps ranged in size from 2cmx4cm-6cm×22cm, and muscle flap were 2cmx2cm-6cmx7cm. The survival rate was 98.3% with only 1 total flap loss due to not reversible venous thrombosis. Primary skin closure on donor-site was performed in 58 patients. Skin grafting was performed in 2 patients. Early postoperative donor-site complications included:infection (n=6), wound dehiscence (n=1), and hematoma (n=1), no skin graft necrosis, no muscle necrosis. The long-term complications included muscle weakness (n=7), unsatisfactory scar appearance (n=3), sensory disturbance (n=50), in anterolateral thigh upper region sensory hypoesthesia (n=10), in anterolateral thigh middle region sensory hypoesthesia (n=39) and sensory deprivation (n=1), in anterolateral thigh lower region sensory hypoesthesia (n=40) and sensory deprivation (n=5). Two patients had intolerance to cold. No muscle herniation, no limitation of range of motion of hip and knee.Conclusions1. Sensory disturbance occurred in anterolateral thigh region of the donor-site especially concentrated in middle and lower area after free anterolateral myocutaneous flaps were made. It was related to damage of lateral femoral cutaneous nerve.2.The bigger size and higher position we make free anterolateral myocutaneous flap, the more risk we will have sensory disturbance on donor-site.3.Muscle weakness were not significantly related to sacrifice of the size of vastus lateralis muscle.4.Few patients were bothered by the appearance of the scar because of the hidden donor-site of the free anterolateral thigh flap.更多还原