Analysis of 27 cases of defect restoration using infrahyoid myocutaneous flap after intraoral cancer surgery
10.3321/j.issn:1673-0860.2008.11.007
- VernacularTitle:舌骨下肌皮瓣修复口腔肿瘤术后缺损27例临床分析
- Author:
Bin LI
1
;
Chun-Hua LI
;
Hua GUO
;
Lin CHEN
;
Shao-Xin WANG
Author Information
1. 四川省肿瘤医院
- Keywords:
Mouth neoplasms;
Surgical flaps
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2008;43(11):826-829
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare different surgical techniques and clinical effectiveness using infrahyoid myooutaneous flap to restore effects after intraoral cancer surgery.Methods It is a retrospective study in Sichuan cancer hospital, from May 1994 to March 2007, 27 cases were treated surgically with unilateral infrahyoid myocutaneous falp, 19 males and 8 famales.Seven cases of squamous cell tongue carcinoma, 4 eases of tongue root carcinoma, 16 cases of mouth floor carcinoma- The biggest flap was 4 cm × 8 cm.In 8 cases, the flap was formed since the remote end reverse vascular traveling and carried with inferior 1/3 muscular tissue of the stemocleidomastoid muscle on the same side (retrograde flap forming), in 19 cases, vascular pedicla was anatomied with microscopic blood vessel-operating skills along vascular traveling before the flap forming( anterograde flap forming).Eleven cases of the reservation vascularized and infrahyoid muscles in the hyoid attachment (combination pedicle), in 16 cases, the arteria and vena thyroidea superior reserved as the pedicel accompanied with the vena jugularis anterior ( the axial vessle pedicle) ; in 21 cases, the distal end of the vena jugulafis interna was tied up at the place where the vena facialis communis joins to the vena jugularis interna, and the vena jugularis anterior was reserved within the flap ( interference return).Results The survival rate of total 27 cases are 77.8%.The flap necrosis in two cases of total group, 1/3 - 1/2 skin necrosis of the flap was found in 4 cases, in the six cases, flap was formed with retrograde flap forming carry with the ipsilateral sternocleidomastoid, the reason of necrosis was venous flow obstruction.Twenty-one flaps of interference return are all survived, the flap in 19 cases with anterograde flap forming all survived, and 16 cases of the axial infrahyoid flap all survived.Follow-up nine months to 13 years with a median follow-up time for four years.Lost four cases, 23 followed up cases did not found on the flap recurrence of cancer.The primary tumor recurrence in three cases, six cases of cervical lymph node recurrence, Kaplan-Meier method statistics 3,5-year survival rates were 69.8%, 47.2%, respectively.Conclusions To improve the survival rate, the surgical approach of anterograde flap forming is suitable, to anatomize the axial vessle pedicle with microscopic skills, in particular should pay attention to ensure that venous return.Carrying with the same side of the sternocleidomastoid muscle tissue and retaining hyoid attachment of infrahyoid muscles will not increase the survival rate of the muscle flap.
