游离前臂桡侧皮瓣重建头颈肿瘤术后缺损

目的：探讨应用游离前臂桡侧皮瓣重建头颈肿瘤切除术后软组织缺损的方法及其效果。方法：2003年1月 至2011年12月采用游离前臂桡侧皮瓣修复头颈恶性肿瘤切除术后软组织缺损70例；其中舌癌43例，颊癌12例，软腭癌 5例，外鼻癌4例，下唇癌3例，上唇癌2例，下咽后壁癌1例。组织缺损范围5 cm×4 cm~14 cm×8 cm，病程 4~30个月。 分析皮瓣修复技术，观察术后皮瓣供区和受区的外观及其影响因素。结果：70例患者中仅1例皮瓣因静脉回流障碍发 生坏死，其余均成活，皮瓣成活率98.4﹪。术后随访12~36个月，1例下咽后壁癌术后1年余死于远处转移，2例舌癌死 于心脑血管意外。术后供区外观平整，有色差，瘢痕不明显，无功能障碍；受区外形接近正常，吞咽顺畅，言语清 晰，修复重建效果满意。结论：游离前臂桡侧皮瓣制作简单，血管解剖恒定，管径粗，蒂长，方便吻合，对供区功 能损伤小，厚薄适中，适合修复头颈肿瘤切除术后软组织缺损和功能重建。

Free radial forearm flap for reconstruction of head and#br# neck soft tissue defects after tumor resection

Objective: To explore the clinical eff ect of the free radial forearm fl ap on repairing tissue defects and reconstructing functions aft er tumor resection. Methods: From January, 2003 to December, 2011, 70 patients, including 43 squamous cell carcinomas of tongue, 12 buccal cancers, 5 carcinomas of the soft palate, 4 basal cell carcinomas of external nose, 3 lower lip cancers, 2 upper lip cancers, and 1 posterior wall of hypopharynx carcinoma, with the soft tissue defects in the head and neck underwent reconstructive operations with the free radial forearm flap after the malignant tumor resection. The area of defects ranged from 5 cm × 4 cm to 14 cm × 8 cm with the process of diseases from 4 to 30 months. Th e technique for graft ing the free radial forearm fl ap and the appearance at sites of the donor and recipient, andthe influence on the anatomy and function in both local sites were analyzed. Results: In the 70 patients, only 1 case of flap appeared necrosis due to venous reflux obstacle, and the remaining (98.4﹪) survived. During the follow-up for 12–36 months, one case of hypopharyngeal carcinoma died from distant metastasis a year later, 2 cases of tongue cancer died of cardiovascular accident. Morphology and function for the sites at donor and recipient were satisfactory. Conclusion: Free radical forearm flap is a good choice for the repair and functional reconstruction for tissue defects after tumor resection.