Study Of Synthetical Evaluation Of The Platysma Myocutaneous Flap For Reconstruction Of Defect Following Oral Cancer Resection

Objective:1. To establish the synthetical evaluation system of functional reconstruction of soft tissue defect following oral tumor resection and assess its clinical value.2. To Evaluate functional effect of reconstruction of soft tissue defect following oral tumor resection by vertical platysma myocutaneous flap (VPMF).To compare the result of the function evaluation.3. To analysis the factors of evaluation results and quality of life for improving the effect of application of VPMF.Methods:1. Experts scored method:to establish the synthetical evaluation system of functional reconstruction of soft tissue defect following oral tumor resection.Direct grading method:to determine the weight coefficient of indicators.2. From2010.5through2012.12,28patients with squamous cell carcinoma of the oral cavity underwent primary reconstruction with a VPMF in Stomatological Department of Xiangya Hospital. Evaluate function and quality of life (QOL) at three time point:preoperative, the1th month and the6th months postoperative.3. Hierarchy process method was used to compare the result of synthetical evaluation between two sorts of VMPF.4. Factors of evaluation results and QOL was tested by spearman non-parameters correlation and analyzed by step method of multiple linear regressions.Results:1. Synthetical evaluation system of functional reconstruction of soft tissue defect following oral tumor resection was established.2. In the28cases, there were3cases complete necrosis and5cases partial necrosis.In8cases neck wound was delayed healing, carotid sheath of1case exposed. The oral movement, chewing and pronunciation function declined at1month postoperative; however73.3%patients recovered at the6th month postoperative. QOL declined at the lth month postoperative, and recovered to preoperative level at the6th month postoperative. The function and appearance in donor site was acceptable at the6th month postoperative. Neck movement:hypsokinesis at an average of30°, rotated32°,and uninjured side was partial to35°.3. The recipient-site function evaluation of two types of VPMF show that muscle pedicle type reconstruction function is better than that of subcutaneous muscle pedicle type.4. The recipient-site function at lth month postoperative significantly associated with a few factors, such as complication(P<0.01), color of skin flap at72hours postoperative (P<0.05) and past medical history(P<0.05). The recipient-site function at6th month postoperative significantly associated with T stage. QOL and function has significant correlation postoperative. The recipient-site function at lth month postoperative was linearly related to the recipient-site complication and past medical history.QOL at lth month postoperative was linearly related to the recipient-site function. The function evaluation result of recipient-site at6months postoperative was linearly related to T stage (αin=0.05,αout=0.10).Conclusions:1. The synthetical evaluation system of functional recon-struction of soft tissue defect following oral tumor resection is concisely when used in clinic. The function has a significant difference in different time periods, which is closely related to the QOL.2. Using Vertical platysma myocutaneous flap to repair small and medium defects of oral maxillofacial region tumor resection has excellent long-term recovery functions and has less impact on motion function and appearance in donor site. QOL recovered postoperative.