Objective: To explore the advantages and clinical efficacy of free chimeric perforator flap based on the descending branch of circumflex femoral artery applied to tongue reconstruction after advanced tongue cancer resection. Methods: From October 2013 to December 2018, 57 cases received tongue and oral base reconstruction surgeries using the descending branch of circumflex femoral artery chimeric perforator flap, including 39 males and 18 females, ranged from 20 to 76 years old. And all cases were with stage T3 and T4 tongue cancers, including 35 cases of squamous cell carcinoma, 7 cases of low differentiation cancer, 5 cases of oncosarcoma, and 10 cases of adenoid cystic carcinoma. The tongue was reconstructed by using perforator flap and muscle flap to fill the dead space at the oral floor. The artery anastomoses with the superior thyroid artery or facial artery in the receiving area, and the vein anastomoses with the internal jugular vein in the receiving area. The shape, function and local complications of the reconstructed tongue were observed after operation. Results: Of 57 cases, only one case had partial necrosis of flap, while other 56 cases with chimeric perforator flap survived. Postoperative gastric tube and tracheal cannula were removed in all patients, no cases with oral fistula. All donor sites were sutured in one stage. Postoperative radiotherapy was performed in 41 of the patients. All patients were followed up for 3 to 60 months (average of 20.7 months), with satisfactory esthetic and functional results in reconstructed tongues. Only linear scars were left in the donor areas of the legs, and no lower limb dysfunction was observed. Conclusions: The descending branch of circumflex femoral artery chimeric perforator flap can used for repairing simultaneously the defects of both tongue and oral base. It is helpful to avoid the occurrence of oral fistula and to provide the reconstructed tongue with a good function. It is a good choice to use the descending branch of circumflex femoral artery chimeric perforator flap for tongue reconstruction after resection of advanced tongue cancer resection.
目的： 探讨旋股外侧动脉降支嵌合穿支皮瓣应用于中晚期舌癌术后一期舌再造的优势和临床效果。 方法： 2013年10月至2018年12月，四川省肿瘤医院应用旋股外侧动脉降支嵌合穿支皮瓣进行舌及口底再造57例，其中男39例，女18例，年龄20~76岁，均为T3、T4期舌癌，其中鳞状细胞癌35例，低分化癌7例，癌肉瘤5例，腺样囊性癌10例，采用股外侧肌瓣填充口底死腔、旋股外侧动脉降支穿支皮瓣再造舌，动脉与受区的甲状腺上动脉或面动脉进行吻合，静脉与受区的颈内静脉属支静脉吻合。术后观察再造舌的外形、功能以及局部并发症发生情况。 结果： 57例旋股外侧动脉降支嵌合穿支皮瓣仅1例出现部分坏死，56例全部成活，术后所有患者均拔除胃管和气管套管，无一例发生口腔瘘，供区均一期缝合。其中41例患者术后行放疗，57例患者术后随访3~60个月，平均20.7个月，所有患者的再造舌形态、质地良好，外形不臃肿，患者语言、吞咽功能满意。腿部供区仅留线性瘢痕，无下肢功能障碍。 结论： 旋股外侧动脉降支嵌合穿支皮瓣能同时修复舌、口底等多个区域的复合缺损，有助于避免口腔瘘的发生，同时不会影响再造舌的运动功能。应用旋股外侧动脉降支嵌合穿支皮瓣对于中晚期舌癌手术的舌修复再造是一种较好的选择。.
Keywords: Lateral circumflex femoral artery, descending branch; Microsurgery; Reconstructive surgical procedures; Surgical flaps; Tongue neoplasms.