THE FATE OF INTRAORAL FREE MUSCLE FLAPS - IS SKIN NECESSARY
THE FATE OF INTRAORAL FREE MUSCLE FLAPS - IS SKIN NECESSARY
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DOI：
10.1097/00006534-199305000-00009
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发表时间：
1993-05-01
影响因子：
3.6
通讯作者：
YETMAN, RJ
中科院分区：
文献类型：
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作者：
ANAIN, SA;YETMAN, RJ
口内游离肌皮瓣用于头颈部粘膜和软组织缺损的重建可能体积大且不灵活。单独的游离肌瓣比肌皮瓣体积小得多，能更好地恢复轮廓。然而，当使用游离肌瓣时，我们认为需要皮肤移植来实现适当的上皮化，而不会出现明显的挛缩。9例患者，平均年龄59岁（42 ~ 71岁），男6例，女3例，仅行头颈部肿瘤切除和游离肌皮瓣重建。填充4 × 4 ~ 12 × 10 cm的黏膜缺损（口底4层，硬腭5层）。重建采用7个游离腹直肌瓣和2个内斜/髂骨瓣。所有皮瓣均存活，无明显并发症。腹部有一处小伤口分离。所有能吞咽的患者术后2周开始口服喂养。即使是较大的缺损，也能在8周内完全上皮化。组织学检查显示，1周时早期纤维蛋白层覆盖在肌肉上，最终上皮化，显微镜下与正常周围粘膜难以区分。所有的皮瓣都有一些挛缩，但这在临床上并不显著，即使在大的缺陷中也是如此。口腔内游离肌瓣提供了一种安全可靠的重建方法，具有良好的功能效果。
Intraoral free musculocutaneous flaps can be bulky and inflexible for reconstruction of mucosal and soft-tissue defects to the head and neck. Free muscle flaps alone can be much less bulky and restore better contour than musculocutaneous flaps. When using free muscle flaps, however, it was felt that a skin graft was needed for proper epithelialization without significant contracture. Nine patients, average age 59 years (range 42 to 71 years), six males and three females, underwent extirpation of head and neck tumors and reconstruction with free muscle flaps only. Mucosal defects from 4 X 4 to 12 X 10 cm (four floor of mouth, five hard palate) were filled. Reconstruction was done with seven free rectus abdominis muscle flaps and two internal oblique/iliac bone flaps. All flaps survived with no significant complications. There was one minor abdominal wound separation. All patients who were able to swallow started oral feedings by 2 weeks postoperatively. Total epithelialization of even the large defects was completed by 8 weeks. Histologic assessment revealed an early fibrin layer over the muscle at 1 week with eventual epithelialization that was indistinguishable microscopically from normal surrounding mucosa. There was some contracture in all the flaps, but this was not clinically significant, even in the large defects. Intraoral free muscle flaps offer a safe and reliable reconstructive method that has led to a good functional result.