• 南京大學醫(yī)學院附屬口腔醫(yī)院口腔頜面外科（南京，210008）;

目的總結應用后橈側副動脈（posterior radial collateral artery，PRCA）穿支嵌合瓣修復舌癌術后軟組織缺損的臨床效果。 方法2011年8月－10月，收治舌部鱗狀細胞癌男性患者5例。年齡43～71歲，平均59歲。病程25～60 d，平均42 d。舌癌病灶擴大切除后，3例1/3舌及口底組織缺損，2例1/2舌及口底組織缺損。應用PRCA設計制備游離延展上臂外側皮瓣（extended lateral arm free flap，ELAFF）與肱三頭肌肌瓣（triceps muscle flap，TMF）形成嵌合瓣，一期修復舌部軟組織缺損。ELAFF切取范圍為7 cm × 5 cm～9 cm × 5 cm，TMF為3 cm × 3 cm～4 cm × 4 cm。供區(qū)直接拉攏縫合。 結果術后嵌合瓣均順利成活，創(chuàng)面Ⅰ期愈合；供區(qū)切口均Ⅰ期愈合?；颊咝g后均獲6個月隨訪。術后舌體外形及運動良好，發(fā)音較清晰，吞咽無障礙。隨訪期間腫瘤均無復發(fā)。供區(qū)肘關節(jié)功能正常，局部有輕微麻木感。 結論應用PRCA穿支制備游離ELAFF及TMF并形成嵌合瓣修復舌部軟組織缺損，其血供可靠，手術操作簡便，能提高修復效果，并發(fā)癥少，是舌癌切除后缺損修復的較好選擇之一。

引用本文： 陳勇,楊旭東,李威,胡勤剛. 后橈側副動脈穿支嵌合瓣修復舌癌術后缺損的早期療效. 中國修復重建外科雜志, 2012, 26(11): 1336-1339. doi: 復制

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2. Calabrese L, Saito A, Navach V, et al. Tongue reconstruction with the gracilis myocutaneous free flap. Microsurgery, 2011, 31(5): 355-359.
3. Kao HK, Chang KP, Chen YA, et al. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast Reconstr Surg, 2010, 125(4): 1135-1145.
4. Haas F, Ensat F, Windhager R, et al. Reconstructive potential of the lateral arm flap after tumor resection. Microsurgery, 2007, 27(3): 166-173.
5. Reinert S. The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery. J Craniomaxillofac Surg, 2000, 28(2): 69-73.
6. Katsaros J, Schusterman M, Beppu M, et al. The lateral upper arm flap: anatomy and clinical applications. Ann Plast Surg, 1984, 12(6): 489-500.
7. Brandt KE, Khouri RK. The lateral arm/proximal forearm flap. Plast Reconstr Surg, 1993, 92(6): 1137-1143.
8. Kuek LB, Chuan TL. The extended lateral arm flap: a new modification. J Reconstr Microsurg, 1991, 7(3): 167-173.
9. Tan BK, Wong CH, Chew W, et al. Use of the slit arteriotomy for end-to-side arterial anastomosis in free-tissue transfers to the extremities. J Plast Reconstr Aesthet Surg, 2009, 62(11): 1519-1523.
10. 陳勇, 楊旭東, 李威, 等. 游離延展上臂外側皮瓣修復洞穿性頰部缺損一例. 中國修復重建外科雜志, 2012, 26(4): 508-510.
11. Marques Faria JC, Rodrigues ML, Scopel GP, et al. The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases. J Plast Reconstr Aesthet Surg, 2008, 61(2): 172-179.
12. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg, 1981, 67(2): 177-187.
13. 王斌, 李康華, 邵新中, 等. 游離肱三頭肌外側頭肌皮瓣修復前臂軟組織缺損. 中華手外科雜志, 2006, 22(3): 165-166.
14. 林浩東, 方有生, 陳德松. 肱三頭肌外側頭移位重建伸腕功能. 中國矯形外科雜志, 2007, 15(1): 67-68.
15. Koshima I. A new classification of free combined or connected tissue transfers: introduction to the concept of bridge, siamese, chimeric, mosaic, and chain-circle flaps. Acta Med Okayama, 2001, 55(6): 329-332.
16. Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg, 2006, 117(7): 151e-160e.
17. 徐中飛, 代煒, 張恩礁, 等. 股前外側穿支嵌合瓣修復頭頸腫瘤根治術后缺損. 上?？谇会t(yī)學, 2012, 21(1): 107-112.
18. Liu WW, Yang AK, Ou YD. The harvesting and insetting of a chimeric anterolateral thigh flap to reconstruct through and through cheek defects. Int J Oral Maxillofac Surg, 2011, 40(12): 1421-1423.
19. Kuo YR, Shih HS, Chen CC, et al. Free fibula osteocutaneous flap with soleus muscle as a chimeric flap for reconstructing mandibular segmental defect after oral cancer ablation. Ann Plast Surg, 2010, 64(6): 738-742.
  1. 1.
  2. 2. Calabrese L, Saito A, Navach V, et al. Tongue reconstruction with the gracilis myocutaneous free flap. Microsurgery, 2011, 31(5): 355-359.
  3. 3. Kao HK, Chang KP, Chen YA, et al. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast Reconstr Surg, 2010, 125(4): 1135-1145.
  4. 4. Haas F, Ensat F, Windhager R, et al. Reconstructive potential of the lateral arm flap after tumor resection. Microsurgery, 2007, 27(3): 166-173.
  5. 5. Reinert S. The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery. J Craniomaxillofac Surg, 2000, 28(2): 69-73.
  6. 6. Katsaros J, Schusterman M, Beppu M, et al. The lateral upper arm flap: anatomy and clinical applications. Ann Plast Surg, 1984, 12(6): 489-500.
  7. 7. Brandt KE, Khouri RK. The lateral arm/proximal forearm flap. Plast Reconstr Surg, 1993, 92(6): 1137-1143.
  8. 8. Kuek LB, Chuan TL. The extended lateral arm flap: a new modification. J Reconstr Microsurg, 1991, 7(3): 167-173.
  9. 9. Tan BK, Wong CH, Chew W, et al. Use of the slit arteriotomy for end-to-side arterial anastomosis in free-tissue transfers to the extremities. J Plast Reconstr Aesthet Surg, 2009, 62(11): 1519-1523.
  10. 10. 陳勇, 楊旭東, 李威, 等. 游離延展上臂外側皮瓣修復洞穿性頰部缺損一例. 中國修復重建外科雜志, 2012, 26(4): 508-510.
  11. 11. Marques Faria JC, Rodrigues ML, Scopel GP, et al. The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases. J Plast Reconstr Aesthet Surg, 2008, 61(2): 172-179.
  12. 12. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg, 1981, 67(2): 177-187.
  13. 13. 王斌, 李康華, 邵新中, 等. 游離肱三頭肌外側頭肌皮瓣修復前臂軟組織缺損. 中華手外科雜志, 2006, 22(3): 165-166.
  14. 14. 林浩東, 方有生, 陳德松. 肱三頭肌外側頭移位重建伸腕功能. 中國矯形外科雜志, 2007, 15(1): 67-68.
  15. 15. Koshima I. A new classification of free combined or connected tissue transfers: introduction to the concept of bridge, siamese, chimeric, mosaic, and chain-circle flaps. Acta Med Okayama, 2001, 55(6): 329-332.
  16. 16. Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg, 2006, 117(7): 151e-160e.
  17. 17. 徐中飛, 代煒, 張恩礁, 等. 股前外側穿支嵌合瓣修復頭頸腫瘤根治術后缺損. 上海口腔醫(yī)學, 2012, 21(1): 107-112.
  18. 18. Liu WW, Yang AK, Ou YD. The harvesting and insetting of a chimeric anterolateral thigh flap to reconstruct through and through cheek defects. Int J Oral Maxillofac Surg, 2011, 40(12): 1421-1423.
  19. 19. Kuo YR, Shih HS, Chen CC, et al. Free fibula osteocutaneous flap with soleus muscle as a chimeric flap for reconstructing mandibular segmental defect after oral cancer ablation. Ann Plast Surg, 2010, 64(6): 738-742.