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| 題 名 | A Double-Skin Paddle Radial Forearm Flap for the Reconstruction of Oral Submucous Fibrosis=雙皮瓣前臂橈動脈自由皮瓣用於口腔黏膜下纖維化的重建 |
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| 作 者 | 李俊達; 鄭立福; 王健興; 許宏達; 陳培榕; 林志明; 簡守信; | 書刊名 | 慈濟醫學 |
| 卷 期 | 18:5 民95.10 |
| 頁 次 | 頁362-369+406 |
| 分類號 | 416.89 |
| 關鍵詞 | 口腔黏膜下纖維化; 雙皮瓣前臂橈動脈自由瓣; 咀嚼肌肉切開術; 喙狀突切斷術; Oral submucous fibrosis; Double-skin paddle radial forearm flap; Masticatory muscle myotomy; Coronoidotomy; |
| 語 文 | 英文(English) |
| 中文摘要 | 目的:口腔黏膜下纖維化可導致逐漸的開口限制。外科治療適用於嚴重的病例。本文描述一種創新的手術:雙皮瓣前臂橈動脈自由瓣(僅用一側的前臂供皮瓣區)來重建兩側的頰黏膜缺損,並報告治療結果。病人與方法:從2002年7月到2004年8月,共6位嚴重口腔黏膜下纖維化的病人接受治療。手術方罄包括(1)鬆解所以口內纖維的組織,(2)咀嚼肌肉切開術及喙狀突切斷術,(3)用雙皮瓣前臂橈動脈自由瓣來重建。結果:術前開口為2至5公釐(平均3.3),經黏膜下鬆解後,術中開口為13至20公釐(平均16.5),經進一步肌肉切開術及喙狀突切斷術後,術中開口為32至42公釐(平均35.5)。2位病人近端皮瓣包含一個穿透枝,4位包含2個穿透枝。皮瓣大小:長8至9公平,寬2至2.5公分。5個皮瓣順利存活,1個皮瓣24小時發生動脈栓塞,經緊急探查,皮瓣成功救回。1位病人出現顳頜關節半脫位,而要手術復位。1位病人因皮瓣太大。需要修正。平均追蹤19個月,術後開口為22至37公釐(平均30)。和術前的上下門齒間距相比,平均增加的開口為26.7公釐。結論:雙皮瓣前臂橈動脈自由瓣(只利用一處共皮瓣區)允許同時重建兩側分開的頰黏腊而免除了第二個自由平瓣。 |
| 英文摘要 | Objective: Oral submucous fibrosis can result in progressive restriction of mouth opening. Surgical treatment is indicated for severe cases. An innovative technique, a double-skin paddle radial foream flap, suing only one forearm donor site to reconstruct the bilateral buccal defects, is described. Patients and Methods: A total of six patients, having sever oral submucous fibrosis, were treated between July 2002 and August 2004. The surgical procedure consists of (1) release of all the intraoral fibrotic tissue, (2) masticatory muscle myotomy and coronoidotomy, and (3) reconstruction with a double-skin paddle radial forearm flap. Results: The preoperative mouth opening was 2 to 5 mm (mean: 3.3mm). The intraoperative mouth opening ranged from 13 to 20 mm (mean 16.5mm) after submucous release and ranged from 32 to 42 mm (mean 35.5mm) after further release via myotomy and coronoidotomy. The proximal flap incorporated on eperforator in two patients and two perforators in the remaining 4 patients. The size of the flaps ranged from 8 to 9 cm in length and 2 to 2.5 cm in width. Five flaps survived uneventfully. Arterial thrombosis, developing 24 hour after the operation, was noted in one flap. The flap was successfully salvaged after emergent exploration. Temporomandibular joint subluxation developed in one patient and required surgical reduction. One patient needed flap revision due to bulkiness. The post-operative mouth-opening range was 22 to 37mm (mean: 30mm) at an average follow-up period of 19 months. The average increase of the mouth opening was 26.7mm, compared with the preoperative interincisor distance. Conclusion: Double-skin paddle radial forearm flap allowed simultaneous reconstruction of two separate buccal defects using a single donor site and thus obviates the need for a second free flap. |
本系統中英文摘要資訊取自各篇刊載內容。