岛状颊肌粘膜瓣修复腭瘘临床研究.docVIP

岛状颊肌粘膜瓣修复腭瘘临床研究 　　[摘要]目的:探索应用岛状颊肌粘膜瓣方法修复较大面积腭瘘的临床实践，探讨该方法的优缺点。方法：应用蒂在前上的岛状颊肌粘膜瓣修复腭瘘4例；应用蒂在后的岛状颊肌粘膜瓣修复腭瘘14例，其中有7例在修复腭瘘的同时延长软腭以矫正腭咽闭合不全。结果：共修复腭瘘患者18例；其中15例腭部瘘孔获得关闭，颊肌黏膜瓣成活良好，无感染、腮腺导管损伤或阻塞、面神经损伤，无张口受限、瘢痕挛缩及咀嚼障碍；2例因岛状颊肌粘膜瓣远端愈合不良再次出现硬腭前端瘘口，但面积较原来明显减小，其中1例再发腭瘘应用已转移到腭部的颊肌粘膜瓣组织行二次手术修复后愈合；1例岛状颊肌粘膜瓣部分坏死。结论：应用蒂在前上和蒂在后的岛状颊肌粘膜瓣修复腭瘘是一种比较安全可靠的方法，其成活率高，可以灵活转移修复各个部位的腭瘘，在修复软硬腭交界部位腭瘘的同时可延长软腭、矫正腭咽闭合不全。即使腭瘘再发，可以应用已转移到腭部的肌黏膜瓣修复之。 　　[关键词]腭瘘；岛状颊肌粘膜瓣；腭裂 　　[中图分类号]R782.05 [文献标识码]A [文章编号]1008-6455（2009）03-0302-05 　　 　　A clinical study on the Buccinator Musculomucosal Island Flap for Palatal Fistula Repair 　　MA Ting-ting,ZHAO Zhen-min,YIN Ning-bei,XIONG Bin,CHENG Ting,WANG Chun-yan,WU Di, 　　YAN Wei,TANG Xin,QIN Yong-ping 　　(The First Department of Plastic Surgery Hospital, Chinese Academic Medical Science and Peking Union Medical College,Beijing 100144, China) 　　Abstract: Objective To explore and evaluate clinical applications of buccinator musculomucosal island flap for palatal fistula repair. Methods The buccinator musculomucosal island flaps pedicled superior-anteriorly based on the distal portion of the facial artery through the anterior buccal branches and pedicled posteriorly based on the buccal artery and posterior branches of the facial artery were designed for palatal fistula repair. 18 palatal fistulae were repaired by this method, 4 pedicled superior-anteriorly and 14 pedicled posteriorly, 7 of which got velopharyngeal incompetence correction at the same time. Results All of the patients got satisfactory fistula closure except 3 complications. One flap got partly necrosis and two got fistulae at the hard palate. However, the fistula sizes were reduced greatly and one has been re-repaired well by the transferred buccinator musculomucosal flap one year later. All the patients had no facial nerves injuries, no limitation in mouth opening and no mastication difficulty. Conclusion The buccinator musculomucosal island flaps pedicled superior-anteriorly and posteriorly are trustwo