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題名 | Reconstruction of Soft Palate Defect Using a Radial Forearm Free Flap and the Palmaris Longus Tendon Complex=使用橈動脈前臂游離皮瓣及掌長肌腱複合物於軟顎組織缺損之重建 |
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作者 | 廖宣凱; 蕭弘道; 董光義; 黃文成; 張世幸; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 22:3 2013.09[民102.09] |
頁次 | 頁216-225 |
分類號 | 416.413 |
關鍵詞 | 軟顎缺損; 掌長肌腱; 游離皮瓣; Radial forearm flap; Soft palate reconstruction; Palmaris longus tendon; Velopharyngeal incompetence; |
語文 | 英文(English) |
中文摘要 | 背景:軟顎缺損可以由於切除良性或惡性的軟顎腫瘤所造成,但是軟顎缺損失去正常動態的說話以及吞嚥功能,所以重建相當困難。而且,以傳統方式重建的時候,最常遇到的問題就是VPI(velopharyngeal insufficiency)。目的及目標:我們設計一種新的帶有掌長肌腱的橈前臂游離動脈皮辦,以此方式重建達到軟顎之部分說話及吞嚥的功能。材料及方法:自2006年11月至2011年10月,16位病人在馬偕紀念醫院接受軟顎切除手術。其中8位病人切除大於1/2的軟顎,並且接受我們的手術方式重建。這種以橈前臂游離動脈重建的軟顎以植皮處做為新的鼻腔側,並有掌長肌腱夾在其中,而夾在其中的掌長肌腱縫合至雙側的喉部肌肉,提供一個懸吊的力量,吞嚥以及說話的功能在術後六個月評估。結果:皮瓣都成功地癒合及存活下來,沒有病患抱怨在吞嚥時逆流至鼻腔的情形,只有一位缺損較大的病患抱怨發出靠軟顎和舌根音時,會有構音的困難(ㄍ,ㄎ,ㄏ,ㄤ,ㄥ)。結論:帶有掌長肌腱之橈前臂動脈之游離皮瓣,提供一個薄的、活動的,並且是提供良好震動的重建之軟顎。而且掌長肌腱之懸吊的力量,在日後追蹤中避免掉了VPI的狀況。 |
英文摘要 | Background:Defects in the soft palate can result from the surgical excision of benign or malignant tumors. Soft palate reconstruction remains a complicated problem because of lost normal mobile function during speech and swallowing. Velopharyngeal insufficiency remains the most significant postoperative problem when traditional methods of reconstruction are used.Aim and Objectives:We designed to reconstruct soft palate using a radial forearm free flap with the palmaris longus tendon to achieve partial velopharyngeal function.Materials and Methods:From November 2006 to October 2011, 16 patients underwent soft palate resection in Mackay Memorial Hospital. Our method was used for soft palate reconstruction in 8 patients who had more than one-half of the soft palate resected. The method involved use of a radial forearm free flap including the palmaris longus tendon inclusion, then covered with a skin graft over the flap on nasal side. The palmaris longus tendon produced a suspension force between bilateral salpiongopharyneal folds. The swallowing and speech function were evaluated 6 months after surgery.Results:All flap survived. No patient complained about nasal reflux during swallowing subjectively. Only 1 patient with large defect complained of difficulty in pronouncing several words mainly from soft palate and tongue base (ㄍ, ㄎ, ㄏ, ㄤ, ㄥ).Conclusion:Free radial forearm flap including the palmaris longus tendon produces a thin, mobile, and adequately resonant soft palate. The palmaris longus tendon provides an added force of suspension that prevents future velopharyngeal incompetence during post-operative period. |
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