[A double-island flap based on the lateral circumflex femoral artery for soft tissue reconstruction after radical resection of advanced oral and oropharyngeal cancer].

内容摘要

Objective: To report the surgical strategy for harvesting a double-island flap based on the lateral circumflex femoral artery (LCFA) for reconstruction of complex soft tissue defects following radical resection of advanced oral and oropharyngeal cancer. Methods: A retrospective analysis was conducted on 93 patients (87 males, 6 females; age range, 32-72 years) with T4-stage oral and oropharyngeal carcinoma who underwent combined jaw-neck radical resection and reconstruction with a single-pedicle double-island anterolateral thigh free flap at the Second Xiangya Hospital of Central South University between July 2020 and September 2025. All flaps were harvested via a medial approach. Perforators in the anterolateral or anteromedial thigh region were identified, and the origin of anteromedial perforators from the LCFA was confirmed following dissection of the rectus femoris muscle. Perforators were then traced retrogradely to the main trunk, and the descending and transverse branches of the LCFA were exposed within the intermuscular space between the rectus femoris and vastus lateralis muscles. Results: The double-island flap was successfully harvested in all 93 patients. Flap combinations included descending+descending branch (n=51), descending+transverse branch (n=26), descending+anteromedial perforator (n=15), and transverse+anteromedial perforator (n=1). In 31.2% (29/93) of cases, anteromedial perforators originated from the LCFA. The mean flap area was (168.20±21.35) cm². The overall mean perforator diameter was (2.49±0.43) mm, with anteromedial, transverse, and descending branches measuring (2.89±0.44) mm, (2.60±0.49) mm, and (2.43±0.39) mm, respectively. The shorter pedicle length was (10.81±1.77) cm, and the longer was (20.53±2.57) cm. In 92 cases, a single arterial and venous anastomosis sufficed. In one case without communicating veins between the two branches, one artery and two veins (the dominant vein from each branch) were anastomosed. Conclusion: The LCFA-based double-island flap provides robust and reliable vascularity, representing an effective reconstructive option for complex soft tissue defects following radical resection of advanced oral cancer. 目的： 探讨基于旋股外侧动脉制备双岛瓣的手术策略。 方法： 回顾性分析2020年7月至2025年9月在中南大学湘雅二医院口腔颌面外科确诊为T4期口腔-口咽癌、并接受颌颈联合根治术及股前外侧游离皮瓣（一蒂双岛）修复重建的93例患者，男性87例，女性6例，年龄32~72岁。皮瓣均经内侧入路制备，术中于股前外侧区或股前内侧区辨识穿支血管，并通过游离股直肌进一步确认股前内侧区穿支起源于旋股外侧动脉；随后逆行解剖穿支至主干血管，并于股直肌与股外侧肌间隙内游离显露旋股外侧动脉的降支与横支。 结果： 93例患者均成功制备股前外侧“一蒂双岛”皮瓣，组合类型包括：降支+降支（51例）、降支+横支（26例）、降支+股前内侧（15例）及横支+股前内侧（1例）。31.2%（29/93）病例中股前内侧穿支起源于旋股外侧动脉。皮瓣面积为（168.20±21.35）cm²。穿支口径总体为（2.49±0.43）mm，其中股前内侧、横支和降支分别为（2.89±0.44）mm、（2.60±0.49）mm和（2.43±0.39）mm。血管蒂较短侧为（10.81±1.77）cm，较长侧为（20.53±2.57）cm。血管吻合方式上，92例患者仅需吻合1根动脉和1根静脉；另有1例因降支与横支静脉未形成交通，遂分别吻合1根动脉及2根静脉（选自回流量较大的降支与横支静脉各一）。 结论： 依托旋股外侧动脉系统制备的双岛皮瓣血运丰富、可靠，是修复晚期口腔癌根治术后复杂软组织缺损的一种有效方法。.