Objective: To introduce the technique and clinical application of free lobed anteromedial thigh perforator pedicle flap. Methods: From September 2015 to September 2021, 72 patients with perforating buccal and oral cancer defects were treated at the Oncology Plastic Surgery Department of Hunan Cancer Hospital. There were 61 males and 11 females, with an average age of 36.7 years (31-56 years). According to Union for International Cancer Control (UICC) TNM staging, there were 20 cases of T3N1M0, 13 cases of T3N2M0, 24 cases of T4N0M0, and 15 cases of T4N1M0. All defects were planned to be repaired with free lobed anteromedial perforator flaps. When there was only one set of vascular pedicle, the perforating vascular pedicle artery was anastomosed with the superior thyroid artery, and the accompanying vein was anastomosed with the superior thyroid vein by end-to-end. Results: The areas of soft tissue defects after radical resection of oral and buccal cancers in 72 patients were between 5.0 cm × 4.0 cm and 11.0 cm×7.0 cm; the areas of the first anterior femoral skin islands were between 5.0 cm × 4.0 cm and 13.0 cm×7.0 cm; the areas of the second anterior femoral skin islands were between 5.0 cm × 3.0 cm and 10.0 cm × 7.0 cm; and all flap donor sites were directly closed. In 35 cases, the vascular pedicle was accompanied by a lateral femoral muscle flap for filling the gap defect at the base of the mouth. The average length of the vascular pedicles of the flaps was 7.2 cm (range: 6.8-8.2 cm). The average diameter of the vascular pedicle arteries was 1.6 mm (range: 1.4-2.2 mm). The blood flow reconstruction of flap was completed by anastomosing one accompanying vein. The average diameter of the accompanying veins was 2.1 mm (range: 1.6-2.8 mm). Postoperative hematoma occurred in 3 patients, with one having vascular crisis. After emergency exploration, 2 of them were successfully saved, and the other one had complete necrosis of skin flap, which was repaired by pedicled pectoralis major skin flap transplantation. With following up of 12-38 months, the appearances of the flaps were satisfactory without significant swelling. The mouth opening and language function were satisfactory in all cases, and only linear scars were left in the donor sites, with no significant impact on thigh functions. Five patients with local recurrence of tumor were treated with second radical resection and repair with pedicled pectoralis major myocutaneous flap. Six patients developed cervical lymph node metastasis (4 on the same side and 2 on the opposite side) and underwent neck dissection again. Conclusion: The anatomical basis of the branches of the anteromedial femoral perforating branches in the anterolateral region of the thigh can be helpful to prepare the anterolateral femoral lobed flap, which is suitable for repairing the perforating defects after the radical operation of oral and buccal cancers.
目的： 介绍游离股前区域分叶皮瓣的制备策略和临床应用经验。 方法： 回顾性分析2015年9月至2021年9月湖南省肿瘤医院肿瘤整形外科收治的72例洞穿性口颊癌缺损病例，其中男性61例，女性11例，年龄为31~56岁。根据国际抗癌联盟（UICC）TNM分期：T3N1M0 20例，T3N2M0 13例，T4N0M0 24例，T4N1M0 15例。计划全部采用游离分叶股前区域皮瓣移植修复。仅有一套血管蒂时，穿支血管蒂动脉与甲状腺上动脉吻合，伴行静脉与甲状腺上静脉端端吻合，有两套血管蒂时第二套穿支血管与面动静脉吻合。 结果： 72例口颊癌肿瘤根治术后遗留的继发软组织缺损面积为5.0 cm×4.0 cm~11.0 cm×7.0 cm；第一块股前区域皮岛面积为5.0 cm×4.0 cm~13.0 cm×7.0 cm，第二块股前区域皮岛面积为5.0 cm×3.0 cm~10.0 cm×7.0 cm，皮瓣供区均直接闭合。在所有病例中，有35例血管蒂同时携带股外侧肌瓣用于填塞口底腔隙缺损。皮瓣血管蒂主干的平均长度为7.2 cm（范围：6.8~8.2 cm），血管蒂动脉的平均管径为1.6 mm（范围：1.4~2.2 mm），所有皮瓣的血运重建仅吻合1支伴行静脉，伴行静脉的平均管径为2.1 mm（范围：1.6~2.8 mm）。术后有3例患者发生血肿，其中1例发生血管危象，急诊探查后成功挽救其中2例，另1例皮瓣完全坏死，采用带蒂胸大肌皮瓣移植补救。随访12~38个月，皮瓣外观满意，未见明显臃肿，患者张口、语言功能满意，供区仅遗留线性瘢痕，大腿功能未见明显影响。5例患者肿瘤局部复发，再次行肿瘤根治术并以带蒂胸大肌皮瓣转移修复。6例患者发生颈部淋巴结转移（同侧4例，对侧2例），再次行颈部淋巴清扫术。 结论： 股前内侧穿支血管发出并分布于股前外侧区域分支的解剖基础可以被充分利用于股前区域分叶皮瓣的制备，适用于口颊癌根治手术后遗留的洞穿性缺损修复。.