两种前臂皮瓣术式对口腔颌面部肿瘤缺损修复后供区恢复及皮肤感觉功能的效果比较

doi:10.19438/j.cjoms.2026.01.007

摘要/Abstract

摘要： 目的: 比较两种前臂皮瓣术式对口腔颌面部肿瘤缺损修复后供区恢复及皮肤感觉功能的效果。方法: 选择2022年1月—2025年1月中国人民解放军联勤保障部队第九一医院收治的口腔颌面部肿瘤患者206例,所有患者均行肿瘤切除术并进行缺损修复,依据皮瓣修复方式不同,分为试验组和对照组,每组各103例。对照组接受传统前臂皮瓣修复术,试验组接受改良前臂皮瓣修复术。比较两组的临床指标、修复效果、口腔功能、供区恢复情况、血液学指标、术后皮瓣成活率及并发症。结果: 两组手术时间、术后住院时间、经口进食时间及血管吻合时间无显著差异（P>0.05）;试验组皮瓣面积显著小于对照组（P<0.05）,试验组修复有效率（91.26%）显著高于对照组（80.58%,P<0.05）。试验组语言功能、外形、开口度、口腔闭合、进食情况、咬合功能、咀嚼功能及吞咽功能评分显著高于对照组（P<0.05）。试验组前臂术区及桡神经浅支一直不麻木的比例显著高于对照组（P<0.05）。术后试验组血清唾液酸（SA）、可溶性白细胞介素2受体（sIL-2R）及C反应蛋白（CRP）水平显著低于对照组（P<0.05）。两组皮瓣成活率、皮瓣危象率及并发症总发生率无显著差异（P>0.05）。结论: 改良前臂皮瓣修复术在皮瓣面积控制、修复效果、口腔功能恢复、供区神经保护及免疫炎症调控方面优于传统术式,安全性相当,值得临床推广。

关键词: 口腔颌面部肿瘤, 前臂皮瓣, 缺损修复, 供区恢复, 皮肤感觉功能

Abstract: PURPOSE: To compare the effects of two forearm flap techniques on donor site recovery and skin sensory function after repair of oral and maxillofacial tumor defects. METHODS: A total of 206 patients with oral and maxillofacial tumors admitted to the 910th Hospital of the Joint Logistic Support Force of the PLA from January 2022 to January 2025 were selected. All patients underwent tumor resection and defect repair, and were divided into an experimental group and a control group according to the different flap repair methods, with 103 cases in each group. The control group was treated with the traditional forearm flap repair technique, while the experimental group was treated with the modified forearm flap repair technique. The clinical indicators, repair effect, oral function, donor site recovery, hematological indicators, and flap survival rate and postoperative complications were compared between the two groups. RESULTS: There was no significant difference in operation time, postoperative hospital stay, oral feeding time, and vascular anastomosis time between the two groups(P>0.05); the flap area in the experimental group was significantly smaller than that in the control group(P<0.05). The effective repair rate in the experimental group(91.26%) was significantly higher than that in the control group(80.58%, P<0.05). The scores of speech function, appearance status, mouth opening, oral closure, eating status, occlusal function, masticatory function, and swallowing function in the experimental group were significantly higher than those in the control group(P<0.05). The proportions of patients with no persistent numbness in the forearm surgical area and the superficial branch of the radial nerve in the experimental group were significantly higher than those in the control group(P<0.05). After surgery, the levels of SA, sIL-2R, and CRP in the experimental group were significantly lower than those in the control group (P<0.05). There were no significant differences in flap survival rate, flap crisis rate, or total complication rate between the two groups(P>0.05). CONCLUSIONS: The modified forearm flap repair technique is superior to the traditional technique in terms of flap area control, repair effect, oral function recovery, donor site nerve protection, and immune-inflammatory regulation, and has comparable safety. It is worthy of clinical promotion.

Key words: Oral and maxillofacial tumors, Forearm flap, Defect repair, Donor site recovery, Skin sensory function

中图分类号:

林天祯, 王文锋, 任常群, 李勇, 周剑虹. 两种前臂皮瓣术式对口腔颌面部肿瘤缺损修复后供区恢复及皮肤感觉功能的效果比较[J]. 中国口腔颌面外科杂志, 2026, 24(1): 40-46.

Lin Tianzhen, Wang Wenfeng, Ren Changqun, Li Yong, Zhou Jianhong. Comparative study on donor site recovery and cutaneous sensory function after two types of forearm flap procedures for defect repair in oral and maxillofacial tumors[J]. China J Oral Maxillofac Surg, 2026, 24(1): 40-46.

参考文献

[1] Song P, Liang Q, Qian Y, et al.Analysis of survival quality of peroneal artery perforator flap in immediate repairment and reconstruction of oral and maxillofacial malignancies[J]. J Craniofac Surg, 2023, 34(5):e474-e477.
[2] Xu Q, Wang SM, Liu YH, et al.Comparison between the radial forearm and groin soft tissue free flaps for reconstruction in patients with oral cavity cancer: a quality of life analysis[J]. Int J Oral Maxillofac Surg, 2022, 51(10): 1289-1295.
[3] Ribeiro LM, Peng C, Mustafa A, et al."Submarine-shaped" radial forearm flap for simultaneous reconstruction of oral and lower lip defects[J]. Ann Plast Surg, 2024, 92(1S Suppl 1): S45-S51.
[4] Al-Aroomi MA, Al-Worafi NA, Ma Y, et al.Patient-reported outcomes after oral cancer reconstructions with radial and ulnar forearm-free flaps[J]. Oral Dis, 2024, 30(8): 4878-4885.
[5] Zhang CF, Liu XJ, Liu DW, et al.Comparison between radial forearm free flap and pectora is major myocutaneous flap for reconstruction in oral cavity cancer patients: assessment of the quality of life[J]. J Craniofac Surg, 2022, 33(3): 906-909.
[6] 中华口腔医学会口腔颌面外科专业委员会肿瘤学组. 口腔颌面部恶性肿瘤治疗指南[J]. 中国口腔颌面外科杂志, 2010, 8(2):98-106.
Division of Oral and Maxillofacial Oncology, Chinese Society of Oral and Maxillofacial Surgery. The protocol of treatment guideline of oral and maxillofacial malignant neoplasms[J]. China Journal of Oral and Maxillofacial Surgery, 2010, 8(2):98-106.
[7] Chang SC, Miller G, Halbert CF, et al.Limiting donor site morbidity by suprafascial dissection of the radial forearm flap[J]. Microsurgery, 1996, 17(3): 136-40.
[8] Makiguchi T, Yokoo S, Takayama Y, et al.Double free flap transfer using a vascularized free fibular flap and a rectus abdominalis musculocutaneous flap for an extensive oromandibular defect: prevention of sinking or drooping of the flap with an anterior rectus sheath[J]. J Craniofac Surg, 2015, 26(7): e622-e624.
[9] Mai L, Mashrah MA, Lin ZY, et al.Posterior tibial artery flap versus radial forearm flap in oral cavity reconstruction and donor site morbidity[J]. Int J Oral Maxillofac Surg, 2022, 51(11): 1401-1411.
[10] Ouyang S, Wu Z, Zhang Y, et al.Comprehensive analysis of risk factors for flap necrosis in free flap reconstruction of postoperative tissue defects in oral and maxillofacial tumors[J]. Sci Rep, 2024, 14(1): 18676.
[11] Hamid MA, Siddiquee BH, Uddin MM, et al.Repair of surgical defect by pectoralis major flap versus free radial forearm flap in buccal carcinoma: assessment of quality of life[J]. Bangladesh J Otorhinolaryngol, 2023, 29(1): 32-38.
[12] Huang W, Chen V, Xie Z, et al.Optimising oral cancer reconstruction: a retrospective cohort study on the modified radial forearm free flap technique to eliminate the need for a secondary donor site[J]. Br J Oral Maxillofac Surg, 2024, 62(3): 265-271.
[13] Sittitrai P, Ruenmarkkaew D, Kumkun C, et al.A retrospective propensity score-matched analysis of oncological and functional outcomes of submental island flap versus radial forearm free flap for oral cavity cancer reconstruction[J]. BMC Oral Health, 2024, 24(1): 190.
[14] 孟宇翔, 宋凯, 何宗轩, 等. 微血管吻合器在股前外侧皮瓣修复口腔恶性肿瘤术后缺损中的应用效果[J].中国口腔颌面外科杂志, 2024, 22(3): 268-273.
Meng YX, Song K, He ZX, et al.Application of microvascular coupler in anterolateral thigh flap for repairing postoperative defects after oral malignant tumor surgery[J]. China Journal of Oral and Maxillofacial Surgery, 2024, 22(3): 268-273.
[15] 张月恒, 崔文举, 宋坤修, 等. 改良CT血管造影术辅助基于浅筋膜穿支的股前外侧皮瓣穿支评估与偏心设计的前瞻性研究[J]. 中华烧伤与创面修复杂志,2023,39(2):141-149.
Zhang YH, Cui WJ, Song KX, et al.A prospective study of the perforator evaluation and eccentric design of anterolateral thigh flap based on superficial fascial perforators assisted by modified computed tomography angiography[J]. Chinese Journal of Burns and Wounds, 2023,39(2):141-149.
[16] 孙黎波, 何芸, 兰玉燕, 等. 改良U形前臂皮瓣修复口腔颌面部中小型软组织缺损的应用[J]. 口腔疾病防治, 2024, 32(7): 517-522.
Sun LB, He Y, Lan YY, et al.Application of a modified Ushaped forearm flap for the repair of small and mediumsized defects in the oral and maxillary areas[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2024,32(7): 517-522.
[17] 李晓高, 邓华, 何倩婷. 前臂梭形皮瓣在口腔颌面部中、小型缺损修复中的应用[J]. 中国口腔颌面外科杂志, 2024, 22(5): 473-477.
Li XG, Deng H, He QT.Application of forearm fusiform flap in repairing medium and small defects in oral and maxillofacial region[J]. China Journal of Oral and Maxillofacial Surgery, 2024, 22(5): 473-477.
[18] 巩自新, 何艳召, 张克勋, 等. 不同修复方法修复口腔颌面部肿瘤术后缺损的效果比较[J]. 实用癌症杂志, 2022, 37(1): 136-139.
Gong ZX, He YZ, Zhang KX, et al.Comparison of different repair methods for oral and maxillofacial defects aftertumor surgery[J]. The Practical Journal of Cancer, 2022, 37(1): 136-139.
[19] Qayyum Z, Khan ZA, Maqsood A, et al.Outcome assessment after reconstruction of tumor-related mandibular defects using free vascularized fibular flap-a clinical study[J]. Healthcare (Basel), 2023, 11(2): 193.