面动脉穿支肌黏膜瓣在前口颊及口角软组织缺损修复中的临床应用与疗效分析OA

Objective To investigate the optimization of clinical application techniques,anatomical advantages and long-term functional efficacy of the facial artery perforator myomucosal flap(FAPMF)in the repair of soft tissue defects in the anterior buccal mucosa and oral commissure regions,with a focus on analyzing its unique value in complex recurrent cases and scenarios requiring oral commissure reconstruction.Methods A retrospective analysis was conducted on the clinical data of 10 patients with soft tissue defects of the anterior buccal mucosa and oral commissure who underwent FAPMF repair from January 2025 to December 2025.Among them,7 were male and 3 were female,aged 38 to 68 years with a mean age of 51.4 years.The etiologies included 8 cases of resection for recurrent oral squamous cell carcinoma after surgery and 2 cases of oral commissure laceration caused by trauma,5 cases had a history of radiotherapy.The defect size ranged from 2.0 cm×2.0 cm to 3.0 cm×3.0 cm.Preoperative dual localization of perforator vessels by computed tomography angiography(CTA)and high-frequency ultrasound was routinely performed.The surgical strategy focused on technical optimization:the"bilobed flap plasty for oral commissure reconstruction"was implemented for oral commissure defects;For patients with poor tissue bed conditions after radiotherapy,the"perforator augmentation"technique were adopted.Postoperative follow-up was conducted to observe flap survival rate,complications,mouth opening degree and aesthetic satisfaction(Visual analogue scale,VAS score).Results All 10 surgeries were successfully completed without conversion to free flap repair.The FAPMF harvest time was 30 to 55 minutes with a mean of 41.2 minutes;The total surgical time was 95 to 165 minutes with a mean of 128.4 minutes.The intraoperative blood loss was 40 to 120 mL with a mean of 72.5 mL.All flaps survived postoperatively,and transient venous congestion occurred in 1 case,which was relieved after partial suture removal and local management.All donor sites were directly closed by primary suture and achieved primary healing.At 6 months postoperatively,the mouth opening degree was(36.45±1.54)mm,and the mean VAS score of patients for mucosal color matching and oral commissure morphology satisfaction was 9.0 points.Conclusion FAPMF is an ideal choice for repairing small and medium-sized defects of the anterior buccal mucosa and oral commissure due to its texture highly matching with oral mucosa,reliable perforator blood supply and flexible rotation arc.Through the optimal application of preoperative precise localization,intraoperative perforator augmentation and oral commissure plasty techniques,the repair risk of post-radiotherapy patients can be significantly reduced,and dual reconstruction of function and aesthetics can be achieved.It is especially suitable for complex cases with poor recipient vessel conditions or the need to preserve major facial blood vessels.