The Application Of Tongue Flap In The Repair Of Tissue Defect In Surgical Resection Of Head And Neck Cancer

Purpose:Laryngeal cancer,hypopharyngeal cancer and oral cancer are relatively common malignant tumors in the head and neck.They are mainly treated by surgery,radiotherapy,chemotherapy and gene targeting.For surgical treatment,surgical resection of complex lesions is challenging in the repair of intraoperative tissue defects.According to the patient's physical condition,TNM stage and postoperative wound size,pedicle myocutaneous flaps,thoracic great myocutaneous flaps,tubular gastric uplift and colon esophagus replacement were used for repair and reconstruction.There have been many reports of tissue defects in oropharynx with tongue flap.In this study,the feasibility,advantages and disadvantages of using tongue flap to repair tissue defects in laryngeal cancer,hypopharyngeal cancer and oral cancer were discussed.Methods:A retrospective analysis of 25 cases of patients with laryngeal,hypopharyngeal and oral cancers diagnosed by electronic laryngoscope,laryngeal enhanced CT or enhanced MR and pathological sections of intraoperative specimens in the department of otolaryngology,first affiliated hospital of zhejiang university from March 2015 to July 2018.To understand postoperative recovery and quality of life through telephone follow-up and outpatient review.Result:1.All of the 1.25 cases were male,aged 50-74 years,with an average age of 62.1 years,including 7 cases of laryngeal cancer,15 cases of hypopharyngeal cancer,2 cases of oropharyngeal cancer,and 1 case of secondary primary cancer:laryngeal cancer and hypopharyngeal cancer.TNM staging:TlN2aM0:l case of type of throat cancer)(the glottis,T1N2cM0:1 case(stomach carcinoma,laryngeal pharynx posterior wall type),ct2n0m0 esophageal cancer:2 cases of laryngeal cancer(1 case of the glottis,1 case of glottis),T2N1M0:1 case(stomach cancer:the piriform fossa type),T2N2bM0:1 case(stomach cancer:the piriform fossa type),T2N2cM0:1 case of type of throat cancer)(the glottis,T3N0M0:3 cases(stomach cancer:the piriform fossa type),T3N2aM0:2 cases(stomach cancer:T3N2bM0:the piriform fossa type),4 cases(1 case of glottis type of throat cancer,3 cases of stomach cancer:the piriform fossa type),T3N2cM0:1 case(stomach cancer:the piriform fossa type),T3N3M0:2 cases of stomach carcinoma(1 case of piriform fossa type + 1 case after ring type),T4aNlM0:1 case(stomach carcinoma:after ring type),T4N1M0:1 case of oropharyngeal cancer,T4N2M0:1 case(stomach cancer:the piriform fossa type),T4aN2aM0:1 case(stomach cancer:the piriform fossa type),T4aN2cM0:2 cases of type of throat cancer)(the glottis.2.Among the 15 cases of hypopharyngeal cancer,bilateral neck dissection was performed in all cases,total laryngectomy was performed in 5 cases,and laryngectomy was performed in 10 cases;Seven patients with laryngeal cancer received bilateral neck dissection and laryngeal preservation.Two cases of oropharyngeal cancer were treated with unilateral neck dissection,bilateral neck dissection,laryngeal preservation,and oral tumor resection.Two primary cancers:laryngeal cancer,hypopharyngeal cancer,intraoperative bilateral neck lymph node dissection,laryngeal surgery.Total laryngectomy was performed in 19 cases(76.0%)and total laryngectomy in 6 cases(24.0%).This group of data of 25 cases,used alone flap reconstruction in 7 cases,combined flap reconstruction 18 cases,joint flap to repair the pectoralis major myocutaneous flap reconstruction in 2 cases,bilateral or unilateral breastbone tongue muscle hyoid bone flap joint flap repair in 11 cases,biofilm joint flap repair in 2 cases,collarbone joint flap island flap to repair in 2 cases,residual larynxes joint flap to repair in 1 case.3.In this study,25 patients had neck infection after surgery(4.0%),(no.20,wu**),and were cured after dressing change.Postoperative pharyngeal fistula occurred in 1 case(4.0%)(serial no.21,sun**),50 days after the operation,transfer of the left thoracic musculocutaneous flap was performed 2 months after the operation to repair the pharyngeal fistula,about lcm of fistula in the left neck,about 0.5cm of fistula in the posterior tracheal wall,and continued to be replaced.Another case(no.15,floor**)had partial necrosis of the supraclavicular skin flap 1 month after surgery,which healed after dressing change,and died of massive hemorrhage in the neck 8 months later.Conclusion:1.Tongue flap is a good method to repair and reconstruct tissue defects after operation of head and neck cancer.It has natural adaptability and anti-infection ability for complex environment with both saliva and bacteria in mouth,pharynx and larynx.High survival rate.2.In the case of indications,tongue or/combined with other flap is an effective method to repair the postoperative defect of head and neck cancer.