Free Fibula Osteocutaneous Flap with Split Skin Paddles for Composite Head and Neck Defect Reconstruction-A Case Report and Literature Review

腓骨游離皮瓣重建口腔癌廣泛切除術後之軟組織及下頜骨缺損──個案報告與文獻回顧

Yao-Cheng Wu(吳曜丞) ； Tzu-Yun Wang(王子勻) ； Shyue-Yih Horng(洪學義) ； Hao-Chih Tai(戴浩志) ； Jung-Hsien Hsieh(謝榮賢) ； Nai-Chen Cheng(鄭乃禎) ； Sung-chuan Chao(趙崧筌) ； Chen-Hsiang Kuan(官振翔)

《臺灣整形外科醫學會雜誌》 32卷4期 (2023/12) Pp. 425-435

摘要

Background: Free osteocutaneous fibula flap (FFF) is considered the optimal option for mandible reconstruction. The literature has introduced different designs of FFF based on various perforators. Split skin paddles based on separated perforators can be utilized to reconstruct composite defects of soft tissue and mandible. However, the anatomical variations of the perforators may limit the use of the double skin paddle FFF. Currently, there is limited literature discussing the comparison between septocutaneous and musculocutaneous perforators of the double skin paddle FFF. Aim and Objectives: Herein, we reviewed the literature and presented a case of composite defects of soft tissue and mandible that was reconstructed with a double skin paddle FFF based on the septocutaneous perforators of the middle third and the distal third calf. Materials and Methods: A 54-year-old male patient with gingival squamous cell carcinoma underwent resection of mandible ramus, gingival mucosa, and outer neck skin. We performed microsurgical reconstruction using a double skin paddle FFF based on the middle and the distal septocutaneous perforator. Results: The mandible contour was successfully restored, and the skin paddles in the oral mucosa and on the neck skin lesion remained in good condition postoperatively at three months. Conclusion: The skin paddle of the FFF can be designed based on the perforators of the peroneal artery, whether they are septocutaneous or musculocutaneous. This provides a versatile flap design that is suitable for composite soft tissue and mandible reconstruction. By using this approach, it may be possible to avoid the need for a double free flap or a single free flap with an additional pedicle flap reconstruction for the composite defect.

關鍵字

double skin paddle free fibular osteocutaneous flap ； double skin paddle ； composite defect ； mandible reconstruction

並列摘要

背景：腓骨游離皮瓣（FFF）發展至今已經是下頷骨重建之首選。目前對於腓骨游離皮瓣的血液供應和穿通支都有更高的認識。在過去文獻中曾介紹隔膜穿通支與肌皮穿通支的解剖。當有需要時，可以使用不同穿通支支配不同皮瓣，用以重建複雜性口腔、下頷骨及皮膚缺損。目的及目標：我們使用兩組隔膜穿通支之腓骨游離皮瓣，重建一例復發性口腔癌病人廣泛切除及下頜骨切除術後的複雜性口腔、下頷骨及皮膚缺損。材料及方法：54歲的男性因左下側牙齦潰瘍就診。病人有口腔癌病史五年前經過廣泛切除及放射治療化療。切片確診為復發性鱗狀細胞癌。切除範圍包含左下口腔黏膜及左下頜骨。我們取腓骨游離皮瓣，利用兩支隔膜穿通支支配兩組皮膚皮瓣，重建複雜性口腔、下頷骨及皮膚缺損。結果：術後成功恢復下頜骨輪廓。病人咀嚼及吞嚥功能恢復良好。術後一個月移除氣切管，三個月術後追蹤口腔及頸部皮瓣癒合良好。結論：腓骨游離皮瓣可根據腓動脈穿通支做分離雙皮瓣，手術難度雖然較高，但適用於複雜軟組織及下頜骨重建，可降低需要使用雙游離皮瓣或胸間皮瓣，減少供區的使用位置及潛在危險。