Abstract:
Objective:To investigate the clinical effect of a segmented perforator flap of free peroneal artery to repair a complex defect after oral cancer. Methods:Forty-eight patients with oral cancer admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022, including 8 of buccal cancer, 7 of floor cancer, 14 of tongue cancer, 5 of retromolar cancet, 9 of maxillary gingival cancer and 5 of mandibular gingival cancer. After lesion resection, 24 patients in the experimental group used the partial perforator flap to repair the defect, and 24 patients in the control group used the single flap to repair the defect. Compared with the general data of the two groups, the difference was not statistically significant(P>0.05), which was comparable. The flap cutting range of the experimental group was 38.5-74.5 cm², and tension-reduced suture for the donor area. In the control group, the myocutaneous flap incision range was 61.0-76.5 cm², and skin graft suture for the donor area. Flap survival and patient survival were recorded and compared. The patients were followed up at 6 and 12 months after surgery, and their swallowing function and speech function, including the drinking water test, functional oral food intake scale and the Chinese language clarity test word table, were evaluated respectively, and their subjective satisfaction with the repair appearance was recorded. Patients in both groups were followed up for 12 to 60 months. Kaplan-Meier method was used to calculate the cumulative survival rate of patients, and survival curves were plotted. log-rank test was used to compare the survival curves between groups. Results:The survival rate of the two groups was 100%. The 5-year survival rate was 62.5% in the experimental group and 54.2% in the control group. There was no significant difference between the two groups (P>0.05). According to the results of the functional recovery evaluation, the groups in swallowing and speech function and subjective satisfaction(P>0.05), and at 12 months after surgery(P<0.05). Conclusion:The segmented perforator flap of free peroneal artery is flexible and can repair different anatomical structures of postoperative composite defect of oral cancer, which can effectively improve postoperative functional recovery and patient satisfaction. Therefore, the peroneal artery segmented perforator flap is the ideal flap for reconstructing postoperative composite defect of oral cancer.
目的:探讨游离腓动脉分叶穿支皮瓣修复口腔癌术后复合性缺损的临床效果。 方法:选取2018年1月—2022年1月蚌埠医科大学第一附属医院口腔颌面外科收治的口腔癌患者48例,其中颊癌8例、口底癌7例、舌癌14例、磨牙后区癌5例,上颌牙龈癌9例,下颌牙龈癌5例。病灶切除术后,实验组24例采用腓动脉分叶穿支皮瓣修复缺损,对照组24例采用腓动脉单叶穿支皮瓣修复缺损。术中实验组皮瓣切取范围为38.5~74.5 cm²,供区减张缝合;对照组皮瓣切取范围为61.0~76.5 cm²,供区植皮缝合。记录并比较2组皮瓣成活以及患者存活情况。术后6个月及12个月分别对患者进行门诊随访,利用洼田饮水试验、功能性经口摄食量表和汉语语言清晰度测试字表分别对患者吞咽功能、语音功能进行评价,并记录患者对修复外形的主观满意度。2组患者均获随访,随访12~60个月,利用Kaplan-Meier法计算患者累积生存率,绘制生存曲线,采用log-rank检验进行组间生存曲线比较。 结果:2组皮瓣成活率均为100%。术后5年实验组患者生存率为62.5%,对照组为54.2%,2组差异无统计学意义(P>0.05)。2组患者术后6个月的吞咽功能、语音功能及主观满意度比较差异均无统计学意义(P>0.05);术后12个月,2组差异均有统计学意义(P<0.05)。 结论:游离腓动脉分叶穿支皮瓣可分别修复口腔癌术后复合缺损的不同解剖结构,可有效提高术后功能恢复程度和患者满意度。腓动脉分叶穿支皮瓣是重建口腔癌术后复合缺损的理想皮瓣。.