Comparison of innervated and noninnervated free flaps in oral reconstruction
Comparison of innervated and noninnervated free flaps in oral reconstruction
复制标题
DOI：
10.1097/00006534-199910000-00010
复制
发表时间：
1999-10-01
影响因子：
3.6
通讯作者：
Harii, K
中科院分区：
文献类型：
--
作者：
Kimata, Y;Uchiyama, K;Harii, K
13例因晚期鳞状细胞癌而切除一半以上舌部的患者接受了重建手术，其中游离皮瓣的皮神经与截断的舌神经残端吻合。8例患者行带神经的大腿前外侧皮瓣重建，5例患者行带神经的腹直肌皮瓣重建。我们比较了这13例患者术后至少6个月皮瓣的感觉恢复情况，以及另外16例接受无神经支配皮瓣修复相同缺损的患者。除冷、热知觉外，有神经支配的大腿皮瓣的感觉恢复程度均明显大于无神经支配的大腿皮瓣，腹直肌皮瓣的感觉恢复程度也明显大于无神经支配的大腿皮瓣。这些结果表明，感觉再生发生在大多数区域通过手术创建的通路。然而，Semmes-Weinstein测试结果显示，两种类型的神经支配皮瓣的恢复均未达到保护感觉的水平。尽管这些发现必须进行额外的客观和功能测试，并应考虑感觉再教育的需要，但这种简单的手术可以改善术后口内功能，应在消融手术后尽可能尝试。
Thirteen patients who had undergone ablative surgery for advanced squamous cell carcinoma in which more than half of the tongue had been resected underwent reconstruction in which the cutaneous nerve of a free flap was anastomosed to the stump of the transected lingual nerve. Eight of the patients underwent reconstruction with an innervated anterolateral thigh flap and five patients underwent reconstruction with an innervated rectus abdominis musculocutaneous flap. Sensory recovery of the flap at least 6 months postoperatively was compared in these 13 patients and in 16 additional patients who received noninnervated versions of the same flaps for the same defect. The degree of sensory recovery of innervated thigh flaps was significantly greater than that of noninnervated ones in all modalities and that of innervated rectus abdominis flaps was also greater than that of noninnervated flaps, except for hot and cold perception. These results indicate that sensory regrowth occurs in most areas through the surgically created pathways. However, results of Semmes-Weinstein testing showed that recovery did not reach the level of protective sensation in either type of innervated flap. Although these findings must be followed by additional objective and functional tests and the need for sensory reeducation should be considered, this simple operative procedure can improve postoperative intraoral function and should be attempted whenever possible after ablative surgery.