| Objective: To use the thoracodorsal artery perforator flap to repair the defect of oral cancer after operation,observe its effect and summarize the clinical experience.Methods: A study was performed on 39 patients who accept thoracodorsal artery perforator(TDAP)flap and 21 patients who accept anterolateral thigh flap(ALT)transplantation after the oral cancer surgery.Collect patients clinical data,the length,width and thickness of flap,vascular pedicle length,the diameter of artery and vein,number of perforators,first perforators from axillary midpoint of the vertical distance,the distance the latissimus dorsi lateral margin of taking the length,the time of the flap harvesting and vascular anastomosis,postoperative hospitalization duration,number of arteriovenous anastomosis,D-dimer,patients on the aesthetics for the area And functional satisfaction rating,etc.Clinical data related to patients were collected and analyzed by SPSS 23.0.Descriptive analysis was expressed by the number of cases and percentage;comparison of measurement data was performed by Student t test and Mann–Whitney u test;comparison of counting data was performed by Chisquare test;p<0.05 was considered as significant difference.Results: There were 60 patients in the two groups,including 53 cases of primary tumor and 7 cases of recurrent tumor.The highest age group was 50 to 60 years old,a total of 26 patients,accounting for 43.3%;Among the 53 patients with primary oral cancer,T2N0M0 was the most,accounting for 49.0%,followed by T2N1M0,accounting for 17.0%.Tongue cancer accounted for 46.7%,followed by buccal cancer,accounting for 33.3%.All flaps survived in both groups,and the survival rate was 100%.The average length of TDAP was 12.3±4.7cm(8cm～28cm).The average width of TDAP was 4.9±0.9cm(4cm～7.5 cm).The mean pedicle length of TDAP was 10.4±1.7cm(8cm～17cm).The mean perforators number of TDAP was 2.2±0.7(1～5).The average length of the first perforator from the axillary was 8.8±0.8cm(7cm～11cm).The average length of the first perforator from the latissimus dorsi front edge was2.3±0.4cm(1.5cm～3.5cm).The average time of TDAP ressection was61.5±11.0min(37min～87min).The mean duration of microvascular anastomosis was 29.2±5.5min(20min～55min).There were 34microanastomosis(87.2%)and 5 cases(12.8%)of moving and static flaps.There were 34 cases(87.2%)accept one artery and one vein,other5 cases(12.8%)accept one artery and two veins.The average thickness of TDAP was 0.6±0.5cm(0.3cm～2.9cm).The average thickness of ALT was 0.9±0.7cm(0.4cm～3.2cm).The thickness of two groups were analyzed using u test,z=-2.862,p< 0.01,results showed statistically significant differences.The average size of TDAP is 63.6±37.5cm~2(32cm~2 ～210cm~2).The average size of ALT is 102.5± 35.4cm ~2(32cm~2 ～168cm~2).The flap size of the two groups were compared and analyzed using u test,z=-3.784,p<0.001,results showed statistically significant differences.The mean diameter of TDAP arteries was 1.7±0.3mm and ALT arteries was 2.0±0.2m.The artery diameter of two groups were analyzed using u test,z =-3.727,p<0.0001,results showed statistically significant differences.The mean diameter of TDAP veins was 2.2±0.3mm,and ALT veins was 2.4±0.3mm.The vein diameter of two groups were analyzed using u test,z =-2.215,p<0.05,results showed statistically significant differences.In the TDAP group,the average value of d-dimer before surgery was0.39±0.58mg/l,the average value of D-dimer within 6h after surgery was1.02±1.07mg/l,and the average value of D-dimer 3～4 days after surgery was 0.97±0.84mg/l.The u test results of D-dimer before and 6h after surgery were as follows: z=-5.313,p<0.0001,results showed statistically significant differences;The u test results of D-dimer before and 3 to 4 days after operation were z=-5.608,p<0.0001,results showed statistically significant differences.The results of D-dimer u test within 6h after surgery and d-dimer u test 3 to 4 days after surgery were z=-0.3,p=0.764>0.05,with no significant differences.In ALT group,the mean value of d-dimer before surgery was0.36±0.27mg/l,the mean value of d-dimer within 6h after surgery was0.77±0.57mg/l,and the mean value of d-dimer 3～4 days after surgery was1.07±0.53mg/l.The u test result of d-dimer before and 6h after surgery was,z=-3.423,p<0.001,results showed statistically significant differences;The results of D-dimer u test were z=-4.328,p<0.0001,results showed statistically significant differences.D-dimer u test results within 6h and 3to 4 days after surgery were z=-2.329,p =0.02<0.05,results showed statistically significant differences.Postoperative pulmonary infection in TDAP group was 1,accounting for 2.6%;The number of postoperative pulmonary infection in ALT group was 3,accounting for 14.3%;The data of the two groups were analyzed by continuous corrected Chi-square test,c2 =1.425(n =1),p >0.05,with no significant differences.The mean postoperative length of stay of TDAP group was 8.5 ± 1.3days and ALT group was 8.8 ± 1.5 days.The postoperative length of stay of two groups were analyzed using u test,z =-0.768,p> 0.05,with no significant differences.The mean patient score of aesthetic and functional satisfaction of TDAP group was 3.6 ± 0.7,ALT group was 3.4 ± 0.8.The score of two groups were analyzed using u test,z =-1.021,p>0.05,with no significant differences.Conclusions:Thoracodorsal artery perforator flap could provide a large amount of tissue for transplantation,stable perforator vessel,long pedicle that can match the requirements of ipomalateral vascular anastomosis,and a vascular diameter that can match the neck vessels.It has a good application effect in the reconstruction of defects after oral cancers.Thoracodorsal artery perforator flap may be an ideal choice for patients with high requirements for scar concealment or high risk of postoperative thrombosis. |
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