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題名 | Free Chimeric Designed Radial Forearm Flap with a Partial Brachioradialis Muscle for Mouth Floor Obliteration in Head and Neck Cancer Reconstruction--Experience at a Single Hospital in Taiwan=使用自由複合式前臂橈動脈皮瓣合併肱橈肌在具有口底缺損之頭頸癌重建經驗 |
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作者 | 錢逸群; 林育賢; 林煌基; 鄭舉緒; 陳柵君; 林上熙; Chien, Yi-chun; Lin, Yu-hsien; Lin, Huwang-chi; Jeng, Chu-hsu; Chen, Cha-chun; Lin, Shang-hsi; |
期刊 | 臺灣整形外科醫學會雜誌 |
出版日期 | 20171200 |
卷期 | 26:4 2017.12[民106.12] |
頁次 | 頁387-395 |
分類號 | 416.413 |
語文 | eng |
關鍵詞 | 複合皮瓣; 前臂橈動脈; 肱橈肌; 頭頸癌重建; Radial forearm free flap; Chimeric flap; Brachioradialis muscle; Head and neck cancer Mouth floor; |
中文摘要 | 背 景:在頭頸部癌症重建的領域裡,前臂橈動脈自由皮瓣多年來一直是個重要的重建工具。該皮瓣具有薄及柔軟的特性,使其在口內缺損或其他較小空間的缺損上一直是個很好的選擇。然而在使用前臂橈動脈皮瓣重建具有口底缺損的傷口時卻因為該皮瓣缺少體積去阻擋口底而容易造成傷口滲漏,進而造成併發症的發生。目的及目標:本文章欲呈現單一醫學中心利用前臂橈動脈及肱橈肌複合皮瓣在頭頸部癌症病人重建的應用經驗,目的是為了減少因滲漏而產生之併發症。材料及方法:在2012/12/1至2016/11/30期間,在敝院共有82位頭頸部癌症病人接受前臂橈動脈自由皮瓣的重建。82位病人中有10位病人接受前臂橈動脈及肱橈肌複合皮瓣重建,10位病人中有一位病人因無口底缺損被排除在此研究,其餘72位病人接受單純前臂橈動脈皮瓣重建。我們回顧了9位接受複合皮瓣病人的基本資料,術中及術後情況,皮瓣存活,以及住院治療過程。我們並比較了接受複合皮瓣以及單純前臂橈動脈皮瓣病人的手術時間。結 果:複合皮瓣的組別中,全部病人(9位)中肱橈肌被用來阻擋口底的缺損。有7位病人皮瓣完全存活,有1位病人皮瓣邊緣有極小部分壞死,有1位病人皮瓣完全壞死。有8位病人住院過程順利並無任何有關滲漏的併發症發生,有1位病人因血管扭折最終皮瓣完全壞死。複合皮瓣以及單純前臂橈動脈皮瓣病人的平均手術時間並無統計上顯著差異(複合:329.9分鐘;單純:351.7分鐘,P值0.1032)。皮瓣供應區並無呈現明顯生理上之傷害及不健全。結 論:臂橈動脈及肱橈肌複合皮瓣在頭頸部癌症重建上是個實用且有效的重建工具,尤其在具有口底缺損之病人具有減少因滲漏而產生併發症的優點。 |
英文摘要 | Background: The free radial forearm flap has been a workhorse flap in reconstruction for patients with head and neck cancer for many years. The radial forearm flap has the characteristics of thinness and pliability, which make it a proper choice for reconstruction of intra-oral defect. Leakage has been a troublesome concern when dealing with defects involving the mouth floor with the radial forearm flap due to lack of bulk. Aim and objectives: We here present our experience using a chimeric radial forearm flap with the brachioradialis muscle in head and neck cancer reconstruction, aiming to reduce complications related to leakage. Materials and methods: Between 2012/12/1 to 2016/11/30, 82 patients underwent reconstructive surgery with a free radial forearm flap. Among these patients, 10 were treated with a chimeric radial forearm flap and 72 patients were treated with a non-chimeric designed radial forearm flap. Among the chimeric flap group, 1 patient with the diagnosis of hypopharyngeal cancer was excluded due to lack of mouth floor defect (the brachioradialis muscle was used as a monitor flap in this case). We reviewed patients' basic data, peri-and post-operative condition, flap survival, and post-operative course of the 9 patients treated with a chimeric radial forearm flap. We also compared the operative time of these 9 patients with those of the remaining 72 patients treated with a non-chimeric designed radial forearm free flap. Results: In the chimeric flap group, the muscle part of the chimeric flap was used to obliterate a mouth floor defect. Total flap survival occurred in 7 patients, minimal flap edge necrosis in 1 patient, and total flap loss in 1 patient. 8 patients had an uneventful hospital course without any complication related to wound leakage. 1 patient experienced total flap loss due to vessel kinking. In the non-chimeric designed flap group, 7 patients experienced complications related to wound leakage with various extent during hospitalization. The mean operative times for chimeric and non-chimeric designed radial forearm flaps were not significantly different (chimeric: 329.9 mins, non-chimeric: 351.7 mins, P=0.1032). Morbidity of the donor site was limited. Conclusion: The chimeric radial forearm and brachioradialis muscle flap is a practical and effective technique in head and neck cancer reconstruction with the advantage of reducing complications related to leakage. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。