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題 名 | Reconstruction of Composite Mandibular Defects in Head and Neck Cancer--The Experience of Shin Kong Memorial Hospital=使用自由腓骨骨皮瓣來重建複雜且由裡到外的下顎骨缺損--新光醫院的重建經驗 |
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作 者 | 林上熙; 林育賢; 林煌基; 鄭舉緒; 謝承翰; 侯勝博; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷 期 | 24:2 2015.06[民104.06] |
頁 次 | 頁105-114 |
分類號 | 416.413 |
關鍵詞 | 下顎骨缺損; 自由腓骨骨皮瓣; Composite mandibular defects; Fibular osteocutaneous flap; Head and neck cancer; |
語 文 | 英文(English) |
中文摘要 | 背 景:要重建複雜且由裡到外的下顎骨缺損是最困難的工作之一。但是自從腓骨骨間隔皮瓣演進成根據腓動脈的腓骨骨肌複合皮瓣之後,有可能只利用單一一塊自由腓骨骨皮瓣就能重建最複雜的下顎骨缺損。目的及目標:我們分析複雜且由裡到外的下顎骨缺損的重建方法,並且提出針對這種複雜且由裡到外的下顎骨缺損的重建流程。材料及方法:從西元2009年一月到西元2012年九月,在新光吳火獅紀念醫院總共有12位頭頸癌的病人需要接受複雜且由裡到外的下顎骨缺損的重建。我們分析口內黏膜缺損、外部皮膚缺損、骨頭缺損的長度、皮瓣的設計、穿透枝的型態術後併發症及捐贈區的後遺症。結 果:全部的皮瓣都有存活。有兩位病人術後發生皮瓣靜脈充血,有三位病人之後有部分皮瓣壞死的情形發生。根據缺損的範圍大小和皮瓣穿透枝的型態,我們可以擬定對於複雜且由裡到外的下顎骨缺損的重建程序。結 論:我們能夠應用單一的複合腓骨骨皮瓣或是摺疊腓骨骨皮瓣來重建複雜、由裡到外的下顎骨缺損。而不需要用到兩塊自由皮瓣。我們的重建流程可以幫助手術醫師選擇適合的方法來重建複雜、由裡到外的下顎骨缺損。 |
英文摘要 | Background: Reconstruction of composite through-and-through mandibular defects represents a most challenging surgical task. Development of the fibular osteoseptocutaneous flap into the peroneal artery-based osteomyocutaneous combined flap has facilitated reconstruction of the most complex composite mandibular defect using single or two-skin paddle fibular osteocutaneous flap. Aim and Objectives: We aimed to analyze the reconstruction procedure for composite mandibular defects after head and neck cancer ablation and to design an algorithm to evaluate reconstruction choices between single or double free flaps. Materials and Methods: From January 2009 to September 2012, 12 head and neck cancer patients required reconstruction of composite through-and-through mandibular defects in Shin Kong Wu Ho-Su Memorial Hospital. We analyzed the size of oral mucosal defects, size of external skin defects, length of bone defects, flap design, type of perforator, complications and donor site morbidity. Results: All flaps survived. Two flaps compromised by venous congestion were salvaged by re-anastomosis. Partial flap loss developed in 3 patients. Based on defect size and type of perforators, we designed an algorithm to determine reconstruction method for composite through-and-through mandibular defects. Conclusion: Single two-skin-paddle fibular flaps or folded fibular flaps can be applied to reconstruct composite through-and-through mandibular defects instead of double flaps. This algorithm offers a selection choice when undertaking reconstruction of through-and-through mandibular defects after head and neck cancer ablation. |
本系統中英文摘要資訊取自各篇刊載內容。