改良U形前臂皮瓣修复口腔颌面部中小型软组织缺损的应用

Application of a modified U-shaped forearm flap for the repair of small and medium-sized defects in the oral and maxillary areas

摘要

目的 探讨改良U形前臂皮瓣在口腔颌面部中小型软组织缺损修复中的应用效果，为临床工作提供参考。方法 本研究已通过单位伦理委员会审查批准，并获得患者知情同意。采用改良U形前臂皮瓣修复口腔颌面部中小型软组织缺损病例10例，其中男8例，女2例，年龄43~72岁，切取皮瓣后，前臂供区创面均可直接拉拢缝合，切取皮瓣面积最大8 cm × 5 cm，最小6 cm × 4 cm。术后随访6个月，观察手部运动（伸指、握拳、向上旋腕及向下旋腕）是否受限，前臂供区及手部是否存在感觉异常，以及前臂供区美观度（采用自主调查问卷，结果为0~10分，0代表非常不美观，10代表非常满意）。结果 10例患者接受改良U形前臂皮瓣的修复方式，所有病例皮瓣均存活，1例患者术后24 h发生静脉危象，经手术探查后皮瓣完全存活。1例患者前臂供区出现延期愈合，其余患者前臂供区创口均1期愈合。术后2周1例患者存在手部感觉异常，在术后3个月恢复。术后6个月时，所有患者手部无运动受限，前臂供区及手部无感觉异常，患者对供区修复美观度基本满意，自主调查问卷结果平均值8.4分。结论 改良U形前臂皮瓣可以直接闭合前臂供区的伤口，避免前臂供区植皮手术，减少了手术创伤，并明显减少了前臂供区的并发症。对于口腔颌面部中小型软组织缺损的修复，改良U形前臂皮瓣可以作为传统前臂皮瓣的替代，是一种比较可靠的修复方式。

Abstract

Objective To evaluate the applicability of a modified U-shaped forearm flap for the repair of small- and medium-sized defects in the oral and maxillary areas to provide a reference for clinicians. Methods This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Ten patients with small- and medium-sized defects in the oral and maxillary areas underwent surgical repair using modified U-shaped forearm flaps. There were 8 males and 2 females aged 43-72 years. The donor site was apposed primarily after harvesting the modified U-shaped forearm skin flap. The flaps ranged from 6 cm × 4 cm to 8 cm × 5 cm in size. Six months after the operation, hand movements (finger extension, fist clenching, wrist rotation upward and wrist rotation downward), the forearm donor site, hand sensations and the satisfaction score for the postoperative quality of the scar at the donor site were evaluated (0 to 10; 0: very unattractive, 10: very satisfactory). Results A total of 10 patients with modified U-shaped forearm flaps survived. One patient developed venous crisis 24 hours after surgery and survived after surgical exploration. Delayed healing occurred at the donor site of the forearm in 1 patient, and the wounds at the donor site of the forearm in the other patients all healed in the first stage. One patient presented with dysesthesia in the hand 2 weeks after surgery and recovered within 3 months. Six months after surgery, all patients had no limited hand movement and no paresthesia at the forearm donor site or hand. The patients were basically satisfied with the appearance of the donor site,and the average satisfaction score of the subjective questionnaire was 8.4 points. Conclusion Modified U-shaped forearm flaps can directly close forearm donor site wounds, which avoids surgical trauma to the secondary donor site and significantly reduces related complications. Modified U-shaped forearm flaps provide an alternative to conventional forearm flaps for the repair of small- and medium-sized defects in the oral and maxillary areas.

关键词

前臂皮瓣 / 并发症 / 缺损 / 修复 / 重建 / 美观 / 手术方式 / 供区

Key words

forearm flap / complication / defect / repair / reconstruct / aesthetics / surgical technique / donor site

Author summay

孙黎波，副主任医师，硕士，Email：[e-mail]