使用三叉戟形感觉性筋膜上股前外侧皮瓣的三维舌重建：技术与功能结局。

文献信息

中文摘要

背景： 肿瘤性舌切除术后舌重建需要恢复三维轮廓、腭接触、感觉和口底支撑。平坦的筋膜皮瓣嵌入可能闭合缺损，但可能无法重建舌的功能解剖。我们描述一种三叉戟形感觉性筋膜上股前外侧皮瓣，用于次全和近全舌重建，并选择性使用嵌合型运动神经支配的股外侧肌组件进行口底重建。
方法： 本描述性病例系列于2023年3月至2025年3月进行。16例舌癌患者在肿瘤切除后使用感觉性筋膜上股前外侧皮瓣进行重建。7例患者仅接受三叉戟形筋膜皮瓣ALT重建，而9例需要嵌合型重建，使用额外的运动神经支配的股外侧肌组件以支撑口底。所有病例均通过拉通入路完成。在股外侧皮神经与舌神经之间进行感觉神经吻合。在嵌合型病例中，至股外侧肌的运动支与舌下神经吻合。在6个月时使用言语清晰度评分、功能性经口摄入量表、MD Anderson吞咽困难量表、EORTC QLQ-H&N35和两点辨别觉评估功能结局。
结果： 队列包括14例男性和2例女性患者，年龄36至61岁。所有患者在6个月时均恢复固体经口摄入。12例患者的FOIS评分为7，4例为6。10例患者的言语清晰度评分为5，6例为4。平均MDADI综合评分为91.2±5.5。EORTC QLQ-H&N35评分显示疼痛、吞咽困难、言语困难和社会进食的症状负担较低。静态两点辨别觉范围为8至15 mm。14例供区一期闭合，2例使用双侧拱石推进皮瓣闭合。
结论： 三叉戟形感觉性筋膜上ALT皮瓣为舌重建提供了一种可重复的三维模板。当口底或舌骨上支撑丧失时，加入神经支配的股外侧肌组件允许将新舌塑形与口底重建分离。这种以缺损为导向的策略与言语、吞咽、感觉和供区方面的良好早期结局相关。

英文摘要

BACKGROUND: Tongue reconstruction after oncologic glossectomy requires restoration of 3-dimensional contour, palatal contact, sensation, and floor-of-mouth support. A flat fasciocutaneous inset may close the defect but may not recreate the functional anatomy of the tongue. We describe a Trishul-pattern sensate suprafascial anterolateral thigh flap for subtotal and near-total tongue reconstruction, with selective use of a chimeric motor-innervated vastus lateralis component for floor-of-mouth reconstruction.
METHODS: This descriptive case series was conducted from March 2023 to March 2025. Sixteen patients with carcinoma of the tongue underwent reconstruction using a sensate suprafascial anterolateral thigh flap after oncologic resection. Seven patients underwent Trishul-pattern fasciocutaneous ALT reconstruction alone, while 9 required a chimeric reconstruction using an additional motor-innervated vastus lateralis component for floor-of-mouth support. All cases were performed through a pull-through approach. Sensory coaptation was performed between the lateral cutaneous nerve of the thigh and the lingual nerve. In chimeric cases, the motor branch to the vastus lateralis was coapted to the hypoglossal nerve. Functional outcomes were assessed at 6 months using speech intelligibility score, Functional Oral Intake Scale, MD Anderson Dysphagia Inventory, EORTC QLQ-H&N35, and 2-point discrimination.
RESULTS: The cohort included 14 male and 2 female patients, aged 36 to 61 years. All patients resumed solid oral intake by 6 months. FOIS scores were 7 in 12 patients and 6 in 4 patients. Speech intelligibility score was 5 in 10 patients and 4 in 6 patients. The mean MDADI composite score was 91.2±5.5. EORTC QLQ-H&N35 scores showed low symptom burden for pain, swallowing difficulty, speech difficulty, and social eating. Static 2-point discrimination ranged from 8 to 15 mm. Donor sites were closed primarily in 14 cases and with bilateral keystone advancement in 2 cases.
CONCLUSIONS: The Trishul-pattern sensate suprafascial ALT flap provides a reproducible 3-dimensional template for tongue reconstruction. When floor-of-mouth or suprahyoid support is lost, the addition of an innervated vastus lateralis component allows separation of neotongue shaping from floor reconstruction. This defect-oriented strategy was associated with favorable early outcomes in speech, swallowing, sensory, and donor-site.