| Background: Large soft tissue defects of the maxillofacial are often left behind after oral cancer surgery,seriously affecting the morphology and physiological function of the patient,which often requires the use of adjacent or distal skin flaps to repair the defect.In recent years,with the establishment of the surgical concept of "precision and minimally invasive" in skin flap surgery,the advantages of the punctured skin flap have become increasingly apparent.The lower abdomen is a commonly used perforator flap donor area.Whether it is the earliest rectus abdominis flap used or the more commonly used DIEP in recent years,it is inevitable to dissect the rectus abdominis.Complications such as abdominal wall hernia may occur.The superficial inferior epigastric artery(SIEA)perforator flap is located on the superficial rectus abdominis,with less damage and fewer complications,and is in line with modern flap surgical concepts.In addition,this flap has been mainly used in breast reconstruction in the past,and has rarely been used in the oral and maxillofacial region.Objectives: 1.To study the role of CT angiography and color Doppler ultrasound in the preoperative design of superficial inferior epigastric artery flaps;2.To explore the short-term clinical effect of superficial inferior epigastric artery flaps in repairing postoperative defects of oral cancer and application characteristics.Methods: A total of 10 patients with oral cancer who were admitted to the First Affiliated Hospital of Bengbu Medical College from January 2018 to June 2019 were selected.There were 6 males and 4 females.There were 8 cases of squamous cell carcinoma,1 case of adenoid cystic carcinoma,and 1 case of mucoepidermoid carcinoma.All patients underwent color Doppler and CT angiography of the superficial inferior epigastric artery.All patients underwent CT angiography and color Doppler ultrasound of the lower abdomen before surgery.According to the size of the affected area defect,based on the imaging location,carefully prepare the skin flap and transfer it to repair the postoperative defect of oral cancer.The anastomosis was successfully performed under the microscope,and the receiving area and the donor area were sutured closely after the vein.The functional recovery was followed up for6-12 months.Results: 9 of the 10 skin flaps in this group survived and 1 was necrotic.All surgical cases were repaired at the same time.There were 6 cases in the left abdomen and 4cases in the right abdomen.Superficial inferior epigastric artery flap was successfully prepared in 9 cases,and 1 case was replaced with superficial circumflex artery flap for repair.The average flap preparation time is about 60 minutes.The size of the flap was5.0cm × 6.0cm ~ 7.0cm × 9.0cm,the thickness of SIEA flap was 1.2cm ~ 3.2cm,and the average thickness was about 1.8cm.According to statistical tests,CT angiography and color Doppler ultrasound showed no significant difference in displaying the branches of superficial inferior epigastric artery and measuring their diameter.The skin color of the flap was ruddy,no obvious deformity,edema,no hair growth,no obvious changes in the patient's appearance,no oro-nasal fistula,no scar contracture leading to moderate and severe open mouth limitation,concealed abdominal incision,and residual linear scar.Conclusion: The superficial inferior epigastric artery flap with small and concealed scars,which is a good choice for repairing postoperative defects of oral cancer.Preoperative angiographic CT and color Doppler ultrasound are important and reliable preoperative examinations,which are helpful to improve the efficiency and accuracy of the operation. |
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