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題名 | Pedicled Latissimus Dorsi/Rib Myo-osseocutaneous Flap Reconstruction for the Mandibular Defect in a Patient with Consecutive Failures of Two Free Fibular Flaps--Case Report and Review of the Literature=利用局部旋轉闊背肌骨骼肌肉皮瓣重建雙側腓骨自由皮瓣重建失敗的口腔癌病患之下顎骨及軟組織缺損--病例報告及文獻回顧 |
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作者姓名(中文) | 許韶芸; 鄭旭堂; 吳肇毅; 張家寧; 陳宏基; | 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243-251 |
分類號 | 416.413 |
關鍵詞 | 自由皮瓣; 頭頸部重建; Latissimus dorsi; Head and neck reconstruction; |
語文 | 英文(English) |
中文摘要 | 背景:自由皮瓣是頭頸部重建最常使用的方法。當自由皮瓣重建失敗,頭頸部開放性的傷口常造成許多併發症。如何適當的治療此類病患是一個很重要的議題。目的及目標:我們報告一個接受癌症切除及兩次腓骨自由皮瓣重建失敗的口腔癌病患,以旋轉闊背肌骨骼肌肉皮瓣重建成功。此類病患其他可能的治療方式也會在文中探討。材料及方法:一位57歲有高血壓及第二型糖尿病病史,罹患第二期左側牙齦及口腔鱗狀上皮細胞癌的男性病患,接受了癌症切除手術,以及兩次腓骨自由皮瓣重建,但接連的兩次腓骨自由皮瓣重建都失敗,造成口腔黏膜,軟組織,以及左下顎骨大範圍的缺損。我們以旋轉闊背肌骨骼肌肉皮瓣完成傷口重建及傷口覆蓋。術後病人傷口愈合良好,可恢復進食功能,臨床結果令人滿意。結果:經過三個月後,移植骨骼血循良好,壞死或再缺損並未出現。臨床結果成功。結論:在頭頸部重建,多次自由皮瓣重建失敗後的處理是相當困難的,特別是合併骨骼缺損的案例。再重複使用自由皮瓣有高的失敗率;而人造植入物合併旋轉肌肉皮瓣常造成許多併發症;旋轉闊背肌骨骼肌肉皮瓣對於此類案例可能是一個良好的重建方式。 |
英文摘要 | Background:Microvascular free tissue transfer has become the choice of reconstruction for complex head and neck defects. For large mandibular defect, free fibular flap is the mainstream flap for the mandibular reconstruction. Despite the advances in microsurgery and the experience gained in clinical practice, management of consecutive two free fibular flaps failures remains challenging to reconstructive microsurgeons.Aim and Objectives:We report a case with large mandible and soft tissue defect after consecutive failures of two free fibular flaps. We successfully reconstructed the defect with pedicled latissimus dorsi/rib myo-osseocutaneous flap.Materials and Methods:A 57 year-old male with a history of hypertension, diabetes mellitus, and recurrent stage II squamous cell carcinoma of lower left gum and mouth was transferred to our hospital with a huge orocutaneos fistula and neck infection. He received surgical resection of left lower gum cancer and segmental mandibuletomy in another hospital. However, the reconstructive procedures were complicated with consecutive failures of left and right fibular flaps. Both flaps were totally lost, and were removed at other hospital. After being transferred to our hospital, we arranged adequate debridement, and the defect was reconstructed with pedicled latissimus dorsi/rib myo-osseocutaneous flap.Results:The bone and soft tissue defect were successfully reconstructed with pedicled latissimus dorsi/rib myo-osseocutaneous flap. The patient regained oral intake in three weeks.Conclusion:Pedicled latissimus dorsi/rib myo-osseocutaneous flap may serve as a good reconstructive alternative for patients with large bone and soft tissue defect after consecutive failures of free fibular flap. This flap may cover the orocutaneous fistula, reconstruct the bony defect, rebuilt the oral function, and prevent further neck infection in one stage. |
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