Abstract:

Objective: To study and evaluate the clinical effects of elongating the pedicle of the submental artery perforator flap used to repair the oral and maxillofacial defects far away from the donor sites. Methods: From January 2019 to February 2021, 15 cases of oral and maxillofacial head and neck malignant tumors were treated with submental artery perforator flaps to repair postoperative defects in Oral and Maxillofacial Oncology Center, Hospital of Stomatology, China Medical University. During the operation, the perforators of the submental artery into the mylohyoid muscle, the perforators into the submandibular gland, or the mylohyoid nerve were dissected and ligated by microdissection. The differences of elongation numerical results before and after perforation treatment of the submental artery perforator flap pedicles were recorded. Results: The range of flap repair covered from the oral cavity to the maxillofacial region. The size of the flap ranged from 3.5 cm×6.0 cm to 6.5 cm×16.0 cm respectively. The length of submental artery perforator flap pedicles can be extended by(0.9±0.2) cm after ligating the perforators into the mylohyoid muscle; (2.0±0.2) cm after ligating the perforators into the submandibular gland; and(1.8±0.2) cm after ligating the mylohyoid nerve. The longest vascular pedicle could be extended by 5.5 cm. During the follow-up period of 2-25 months, all flaps survived with good blood supply in 15 patients, and no donor site complications such as flap with insufficient blood supply, necrosis, or facial nerve dysfunction were found immediately after surgery or in follow-up visits. Conclusion: Submental artery perforator flaps can repair oral and maxillofacial defects by elongating the length and rotation radius of vascular pedicles through ligating the submental artery perforators into the mylohyoid muscle, perforators into the submandibular gland and mylohyoid nerve. This technique has more clinical application selectivity and guiding significance to repair small and medium-sized maxillofacial defects far away from the donor sites.

Key words: prolonging the vascular pedicle, submental perforator flap, reconstruct defect

摘要：

目的：本研究通过延长颏下动脉穿支皮瓣（submental artery perforator flap，SMAPF）血管蒂的3种方法修复口腔颌面部距供区较远的缺损，并对其可行性及临床效果评价。方法：选取自2019年1月—2021年2月于中国医科大学附属口腔医院颌面头颈肿瘤外科就诊并收治，行同侧颏下动脉穿支皮瓣手术修复口腔及颌面头颈部恶性肿瘤术后缺损的15个病例。术中通过精细解剖并依次切断颏下动脉进入下颌舌骨肌的穿支、下颌下腺的穿支及切断下颌舌骨肌神经，记录利用上述3种方式行穿支皮瓣血管蒂延长术前后差值的数据。结果：皮瓣修复范围从口腔内至颌面部，大小为3.5 cm×6.0 cm~6.5 cm×16.0 cm。通过切断颏下动脉进入下颌舌骨肌的穿支后血管蒂可延长（0.9±0.2） cm，切断颏下动脉进入下颌下腺穿支后的血管蒂可延长（2.0±0.2） cm，切断下颌舌骨肌神经后血管蒂可延长（1.8±0.2） cm，血管蒂最长可延长5.5 cm。在2~25个月的随访中，15例患者的皮瓣均完全成活，血供较好，术后即刻及随访中无1例皮瓣出现供血不足、坏死或发生面神经功能障碍等供区并发症。结论：颏下动脉穿支皮瓣可以通过切断颏下动脉进入下颌舌骨肌的穿支、下颌下腺穿支及切断下颌舌骨肌神经进行血管蒂延长进而延长旋转半径来修复口腔颌面部缺损。该技术对于修复颌面部距供区远处的中小型缺损具有更多临床应用的选择性和指导意义。

关键词: 延长血管蒂, 颏下穿支皮瓣, 修复缺损