颏下岛状皮瓣在头颈外科的应用

目的 结合应用颏下岛状皮瓣修复头颈肿瘤术后组织缺损的体会,对颏下岛状皮瓣的解剖、制作、适应证及优缺点等进行论述。方法 以面动脉、面静脉的分支支颏下动、静脉为蒂制成岛状皮瓣,采用逆行解剖法,先切取皮瓣,由前向后连同同侧颌下腺向近心端分离,解剖出面动脉,保留颏下动脉、静脉,切除颌下腺及淋巴结。结果 进行颏下岛状皮瓣修复的16例患者,成活15例,失败1例,成功率93．8％。结论 颏下岛状皮瓣适用多种头颈肿瘤术后的一期重建,它具有长而可靠的血管蒂,操作简单,供皮区缝合后切口隐蔽,对外观影响较小,无需血管吻合等优点。但对术前放疗供皮区包括在放疗野内之患者以及颏下、颌下有淋巴结转移的患者,该皮瓣不适用。     

颏下岛状皮瓣同期修复口腔癌术后缺损的临床应用

目的：观察颏下岛状皮瓣（SIF）同期修复口腔癌术后缺损的临床效果。方法回顾分析60例口腔癌术后缺损患者临床资料,将其按照治疗方法分为试验组和对照组,每组30例,试验组应用颏下岛状皮瓣进行术后缺损的修复,对照组应用前臂的桡侧皮瓣进行术后缺损的修复,对比2组的临床疗效。结果???试验组临床疗效有25例为优,4例为良,其优良率达到96.7%,而对照组20例为优,6例为良,其优良率仅86.7%,2组相较,无明显差异（P>0.05）。试验组平均手术时间为（45.72±7.64）min,对照组平均手术时间为（60.14±10.68）min,2组的差异有统计学意义（P<0.05）。试验组平均术中出血量为（23.33±4.13）mL,对照组平均出血量为（27.79±5.38）mL,2组的差异有统计学意义（P<0.05）;2组均未出现颈部的切口感染等相关临床并发症。结论口腔癌术后缺损应用SIF进行同期修复,不仅皮瓣的制备操作简单,而且手术用时也较短,术中出血量较少,患者取瓣伤口较隐蔽,皮瓣修复成活率高,效果显著。     

颏下岛状皮瓣修复口腔癌术后组织缺损15例

目的:总结应用颏下岛状皮瓣修复口腔癌术后组织缺损的临床经验。方法:对1999～2004年采用颏下岛状皮瓣同期修复口腔癌术后组织缺损15例资料进行分析。结果:15例患者中,14例皮瓣全部成活,1例皮瓣部分坏死,经短期换药后愈合,术后随防3月～4年,外形和功能均满意。结论:颏下皮瓣具有长而可靠的血管蒂,操作简单,供区隐蔽,对外观影响小,是一种修复口腔癌术后中小型组织缺损的较好方法。     

颏下岛状皮瓣在修复舌癌术后缺损中的临床应用

目的:探讨颏下岛状皮瓣在修复舌癌术后组织缺损中的临床应用价值。方法:利用5具经10%甲醛溶液固定的国人成人男性标本,对颏下动脉相关解剖进行观测,并结合我院2005-09—2008-06使用颏下岛状皮瓣修复的9例舌癌患者进行临床回顾性分析。结果:颏下动脉走行恒定。9例颏下岛状皮瓣均成活,2例皮瓣远端表面部分坏死。修复后的舌黏膜表面光滑,运动受限不明显,吞咽功能良好。结论:颏下岛状皮瓣供血血管恒定,制备简单,成活率高,供区并发症少,且能够耐受放疗,是修复舌癌术后组织缺损较理想的皮瓣。     

应用颏下岛状皮瓣修复24例早期口腔癌术后缺损疗效评价

目的： 评价应用颏下岛状皮瓣修复早期舌、颊、牙龈癌术后组织缺损的疗效。方法： 选择2014年11月—2017年8月收治的24例早期口腔癌患者,其中舌癌16例,牙龈癌5例,颊癌3例。患侧行肩胛舌骨上颈淋巴清扫术后,扩大切除病灶,同期应用3 cm×4 cm～5 cm×7 cm颏下岛状皮瓣修复组织缺损,对皮瓣成活、肿瘤复发、患者生存时间与生存质量进行评价。结果： 23/24例皮瓣成活,成活率为96%。术后随访3～30个月,1例牙龈癌局部复发,复发率为4%;2例舌癌远期颈部淋巴结转移,发生率为8%。患者言语、进食基本正常,对口腔形态及功能比较满意,随访期内未发生死亡病例。结论： 传统带蒂颏下岛状皮瓣制备简单,成活率高,手术创伤小,术后护理容易,是修复早期舌、颊、牙龈癌术后缺损的一种比较安全、可靠的方式。     

颏下岛状皮瓣的解剖研究及临床应用进展

颏下岛状皮瓣于1993年由Martin等[1]首先报道。该皮瓣颜色、质地与面部组织十分相似、外观自然;皮瓣蒂长、旋转范围大;可提供的皮肤组织量大;血供稳定、成活率高;供区隐蔽,可以一期缝合;而且操作较为简单,手术及住院时间短,目前已成为修复头颈部缺损的重要皮瓣之一。本文现将该     

颏下岛状皮瓣在口咽癌术后缺损修复中的应用

目的:探讨颏下岛状皮瓣修复口咽癌术后缺损的临床效果,为临床应用提供经验。方法:选择口咽癌患者13例,其中鳞状细胞癌12例,肌上皮癌1例,行原发灶切除术及颈淋巴清扫术,采用颏下岛状皮瓣修复术后缺损。结果:13例患者中,12例皮瓣全部成活,1例皮瓣远心端坏死,经修剪换药后愈合,术后随访3个月～3 a,未见原发灶复发及颈部淋巴结转移,均获得良好的进食、语言功能。结论:颏下岛状皮瓣毗邻口咽区,供区位于颈淋巴清扫切口线,操作简单、方便。口咽癌I区淋巴结转移较少,用于修复口咽术后中小组织缺损安全有效,具有良好的临床应用价值。     

颏下岛状皮瓣在颊癌缺损修复中的临床应用

目的探讨颏下岛状皮瓣在修复颊癌缺损中的应用。方法对7例颊癌术后的缺损的患者,同期行颏下岛状皮瓣修复。结果随访6～36个月,7例皮瓣均完全成活,未发生感染、坏死等并发症,无下颌缘支面瘫症状,皮瓣色泽红润,言语功能恢复良好。结论颏下岛状皮瓣血供恒定,制备简单,供区并发症少,成活率高,是修复颊癌术后组织缺损较理想的皮瓣。     

颏下岛状皮瓣在口腔颌面部肿瘤切除后软组织缺损修复中的应用

目的探讨颏下岛状皮瓣在口腔颌面部肿瘤切除后软组织缺损修复中的应用。方法分析颏下岛状皮瓣修复口腔颌面部肿瘤切除后软组织缺损7例,观察其近期临床效果。结果应用颏下岛状皮瓣修复7例患者,6例全部成活,1例出现小部分坏死,外观与功能满意。结论颏下岛状皮瓣具有供区隐蔽、距离近、厚度适中、易于成活、手术便利等优点,是口腔颌面部肿瘤切除后软组织缺损修复的较理想选择。     

颏下血管与颏下岛状瓣应用

颈部皮瓣色泽优良 ,因而 ,临床常用来整复面部软组织缺损。通常应用 3种类型的组织瓣 :随意瓣、颈阔肌肌皮瓣和锁骨上神经血管瓣。每一类型都存在着缺点。随意瓣移动受限 ,供区疤痕不可接受 ;颈阔肌肌皮瓣术后效果难以预测 ;而锁骨上神经血管瓣仅能达到面下 1 / 3区域 ,而且需要广泛分离组织以便于转位。　　颏下岛状瓣是整复口腔颌面部组织缺损又一新的手段 ,且优点较多。自 1 993年Martin等[1 ] 报道以来 ,国内外学者在颏下岛状瓣的应用解剖学方面进行了深入的研究 ,在临床应用方面作了广泛的探讨 ,就这一问题的现状作一简介。1　颏下血…     

颏下岛状肌皮瓣血管的解剖与超声评价

目的探讨应用彩色多普勒超声检测颏下岛状肌皮瓣(submental musculocutaneous island flap),SMIF血管的显示价值,为SMIF的临床应用提供影像学信息。方法选取拟行SMIF移植的患者35例,术前应用彩色多普勒超声测量双侧颏下动脉起始处距离下颌骨下缘、下颌角及颏中点的距离;在超声下探测血管走行,同时行面前静脉、颌外动脉体表标记,并与术中所见血管解剖情况进行对比。结果 35例患者术前超声检测与术中所见符合率为100%;经超声探测出面前静脉的6种走行方式,颌外动脉的4种走行方式;测得左侧颏下动脉起始处距离下颌骨下缘的距离为(0.53±0.09)cm,距离下颌角的距离为(1.82±0.33)cm,距离颏中点的距离为(6.08±0.52)cm;右侧颏下动脉起始处距离下颌骨下缘的距离为(0.52±0.09)cm,距离下颌角的距离为(1.75±0.29)cm,距离颏中点的距离为(6.12±0.63)cm。结论彩色多普勒超声可以直观地显示SMIF血管的走行、分布及变异情况,从而为SMIF的制备提供影像学依据。     

去上皮逆行面动脉-颏下动脉颏下岛状瓣修复上颌术后缺损

目的：探讨去上皮逆行面动脉-颏下动脉颏下岛状瓣对上颌骨术后缺损的修复效果。方法：回顾性研究我科自2007年3月-2009年1月应用去上皮逆行面动脉-颏下动脉颏下岛状瓣修复上颌骨术后缺损病例13例。其中男9例。女4例。所有病例均经病理学检查确诊,其中10例诊断为上颌牙龈鳞状细胞癌,其余3例诊断为硬腭鳞状细胞癌。依据Brown等提出的上颌骨缺损分类法,术后缺损为2a型．用以同期修复的面动脉-颏下动脉岛状瓣长度约8～10cm．宽度约4～5cm。结果：面动脉-颏下动脉岛状瓣的存活率为92.3％（12／13）,未见供区并发症及面神经下颌缘支损伤。随访8～24个月．1例原发灶复发后死亡,2例颈淋巴结复发。结论：去上皮逆行面动脉-颏下动脉颏下岛状瓣具有安全、简单、易于改良等优点,适用于无区域性淋巴结转移的恶性肿瘤术后上颌骨缺损修复。     

The submental island flap: Pedicle elongation and indications in head and neck reconstruction

BackgroundThe submental island flap is an axial pattern skin flap first described by Martin et al. in 1993. When used to reconstruct skin defects it matches the recipient site in terms of colour, texture and thickness. One of the main limitations to its application is the arc of the pedicle allowing coverage of only the lower two thirds of the face.MethodsA retrospective review was performed of all patients who had had a submental island flap reconstruction at the Operative Unit of Maxillo-Facial Surgery of the University Hospital of Parma, Italy, between 2001 and 2011.The Authors focused on the surgical technique adopted, the clinical indications and the results obtained. They analysed the different ways to elongate the pedicle and discuss their thoughts on the choice of reconstruction. A flowchart was created to help in the decisional process.ResultsBetween 2001 and 2011 the submental island flap was used to reconstruct head and neck defects in 22 patients. Thirteen patients had defects of the oral cavity; the remaining 9 patients had skin defects involving the pre-auricular region, the temporal area and the peri-nasal cheek skin.No major complications occurred and in one case a partial necrosis of the distal portion of the flap was observed. Five patients underwent surgical revision involving intraoral flap debulking 6–10 months after the primary procedure.Discussion and conclusionsThe techniques to elongate the pedicle used and described were: additional dissection of the pedicle, Y–V procedure, reverse flow flap, section of facial vein and microvascular anastomosis. Their choice is mainly conditioned by the site of the defect.     

Reverse facial artery-submental artery deepithelialised submental island flap to reconstruct maxillary defects following cancer ablation

Objective

The present study assessed the reliability of the reverse facial artery-submental artery deepithelialised submental island technique to reconstruct maxillary defects.

Methods

The study included 13 patients (9 men and 4 women; 43–62 years) with maxillary defects resulting from cancer ablation. Ten patients presented with maxillary gingival squamous cell carcinoma and the remaining 3 cases were hard palate squamous cell carcinomas. The maxilla was resected and the remaining defects were classified as Class 2a. Reverse facial artery-submental artery deepithelialised submental island flaps measuring 8–10 cm in length and 4–5 cm in width were used to reconstruct the defects.

Results

Twelve of the 13 flaps survived. No donor-site problems or palsy of the marginal mandibular branch of the facial nerve occurred. The follow-up period ranged from 8 to 24 months, 1 patient died as a result of local tumour recurrence and 2patients developed cervical recurrence.

Conclusion

The reverse facial artery-submental artery deepithelialised submental island flap is safe, quick and simple to use or elevate. The flap is a reliable technique for reconstructing maxillary defects following cancer ablation.     

Reverse facial–submental artery island flap for reconstruction of oropharyngeal defects following middle and advanced-stage carcinoma ablation

To assess the reliability of the reverse facial–submental artery island flap for reconstruction of oropharyngeal defects after resection of intermediate stage and advanced carcinomas, we studied 13 patients with stage III and IV squamous cell carcinoma (SCC) of the oropharynx. They had all had their tumours excised followed by reconstruction of the oropharyngeal defect using a facial–submental artery island flap. There was no major failure of a flap, but two minor ones. The marginal mandibular branch of the facial nerve remained intact and undamaged. All donor sites healed well and scars were well-hidden. The functional results of speech and swallowing after 10–28 months’ follow-up were satisfactory. One patient developed lung metastases. The facial–submental artery island flap is a simple, reliable flap that can be used for reconstructing oropharyngeal defects after resection of medium and advanced carcinomas of the oropharynx.     

前臂皮瓣、股前外侧穿支皮瓣及颏下岛状皮瓣修复舌癌患者术后生活质量评估

目的:评估应用前臂皮瓣(radial forearm free flap,RFFF)、股前外侧穿支皮瓣(anterolateral thigh perforator flap,ALT)、颏下岛状皮瓣(submental island flap,SIF)修复舌癌患者手术相关因素及术后生活质量,明确舌癌切除的最佳修复方法.方法:2004年10月-2014年10月期间,应用RFFF、ALT、SIF修复90例舌癌患者术后缺损,随访观察半年,分析患者手术时间、住院天数、皮瓣面积及3种皮瓣修复对患者术后生存质量的影响.患者在手术后复诊时自行完成华盛顿大学生存质量问卷量表第4版(University of Washington Quality of Life Questionnaire version 4,UW-QOLv4)填写.采用SPSS17.0软件包对数据进行统计学处理.结果:3组手术时间差异显著(P＜0.05).ALT组与SIF组住院天数差异显著(P＜0.05),其余2组无显著差异.3组皮瓣面积差异显著(P＜0.05).外貌方面,ALT组与RFFF组有显著差异(P＜0.05),其余2组无显著差异.行动方面,ALT组与SIF组、ALT组与RFFF组有显著差异(P＜0.05),SIF组与RFFF组无显著差异.3组在咀嚼、吞咽、语言、疼痛等10方面及总QOL得分无显著差异.结论:3种皮瓣修复舌癌术后缺损总生存质量无显著差异,均为舌癌术后缺损修复的理想皮瓣.皮瓣选择需根据组织缺损的类型及大小、手术条件与患者的自身情况等综合考虑.     

Indication for and technical refinements of submental intubation in oral and maxillofacial surgery

INTRODUCTION: In maxillofacial injuries, a choice has often to be made between different ways of intubation when surgical access to both the nasal and the oral cavities is necessary. Submental intubation is an interesting alternative to tracheotomy, especially when short-term postoperative control of the airway is foreseeable, and as control of the dental occlusion is complete, and access to the nose and mouth is undisturbed. MATERIAL: This kind of intubation has been used in our department in 25 cases since 1997. All patients had fractures disturbing the dental occlusion plus either an associated fracture of the skull base, or a displaced nasal fracture. RESULTS: There was no intra-operative complication, average intubation duration was 1.5 days. Post-operative complications consisted of one case with hypertrophic scarring and two cases of abscess formation in the floor of the mouth. All these completely healed following local conservative treatment. CONCLUSION: Submental intubation demands certain technical skills but it is simple, rapid and may avoid tracheotomy in selected patients.