耳鼻喉科醫師以游離皮瓣施行頭頸部顯微重建手術：連續130例之經驗

Microsurgical Reconstruction in Head and Neck Using Free Flaps by Otolaryngologists: The Experience of 130 Consecutive Cases

蘇金泉(Chin-Chuan Su) ； 陳穆寬(Mu-Kuan Chen)

《台灣耳鼻喉頭頸外科雜誌》 45卷3期 (2010/06) Pp. 76-81

https://doi.org/10.6286/2010.45.3.76

摘要

背景：頭頸部癌症患者在進行腫瘤根除性手術後，往往需要進行重建手術，以期恢復美觀與功能。區域性旋轉皮瓣的選擇性較少而且受限於長度與體積，並無法完全適合於極爲複雜的頭頸部解剖構造，因此可能會限制術後美觀與功能的恢復。顯微血管游離皮瓣因爲選擇性較多，可以取得適當大小與形狀的皮瓣，而且依照頭頸部接合血管的部位可以修補的位置範圍較廣，可以更成功的達到重建的目的。
方法：在詳細評估患者腫瘤原發部位、大小、病理組織、頭頸部淋巴轉移情形後，選擇最適合的游離皮瓣作顯微重建手術。主要的顯微血管游離皮瓣手術分爲橈側前臂筋膜皮瓣(radial forearm fasciocutaneous flap)和前外側大腿皮瓣(anterolateral thigh flap)。全部手術皆採取兩組耳鼻喉科醫師團隊，一組團隊施行腫瘤切除，另外一組團隊進行顯微血管游離皮瓣重建手術。在取下適當大小的皮瓣，將皮瓣精確穩固地縫合至傷口，並在手術顯微鏡下，以9-0 nylon進行血管吻合。術後密切評估皮瓣的溫度、顏色、形狀並且使用血管超音波來監測接合血管的通暢情形。
結果：自2005年12月至2009年3月共有127名病患實施129次頭頸部顯微血管游離皮瓣的重建手術。年齡分布從35歲至75歲，平均年齡爲52.5歲。性別方面，124名男性、3名女性。皮瓣種類方面，共有橈側前臂筋膜皮瓣98名和前外側大腿皮瓣31名。皮瓣移植的成功率爲97.7%，129個顯微血管游離皮瓣手術有126個存活；局部皮瓣壞死則有4個。
結論：面對極爲複雜而精細的頭頸部解剖構造，顯微血管游離皮瓣手術可以提供較爲量身訂作的多樣化皮瓣來達到成功重建的目的。耳鼻喉科醫師具有完整而豐富的經驗，並且專精了解頭頸部解剖構造與生理功能，經由特殊的顯微血管重建手術訓練，耳鼻喉科醫師可以完成頭頸部顯微重建手術。

關鍵字

游離皮瓣重建手術 ； 頭頸部重建手術

並列摘要

BACKGROUND: In order to maximize function and restore cosmesis, head and neck reconstruction is necessary for patients with head and neck tumors undergoing surgery. There are only a few types of regional flaps we can choose from and they are limited in terms of the rotation of arc, volume and thickness. In addition, they can not reconstruct the complex space of the head and neck region very well. As a result, the function and cosmesis can not be maximally restored. There are a wide range of microvascular free flaps we can choose from for the reconstruction of different head and neck defects with suitable shape and thickness. Through the location of recipient vessels and the length of pedicle of flap, we can perform a wide range of reconstructive surgery to achieve a more successful reconstruction goal.
METHODS: After the primary tumor site, histology, and lymph node staging of patients with tumors were carefully assessed, the appropriate type of microvascular flap was chosen. The main types of free flaps we used included the radial forearm fasciocutaneous flap, and the anterior lateral thigh flap. A two-team approach was always used for tumor resection and free flap reconstruction. After designing and raising the flap, it was secured with correct alignment to the defect. Using an operating microscope, vessels of similar diameter were matched for anastomosis with 9-0 nylon. After the operation, flaps were monitored clinically by color, temperature, and turgor. Doppler signal was also used for the patency of vessels.
RESULTS: From December 2005 to May 2009, there were 129 microvascular surgeries on 127 patients, ranging in age from 35 years to 75 years, with a mean of 52.5 years. There were 124 men and 3 women. Radial forearm fasciocutaneous flaps were used in 98 cases, and anterolateral thigh flaps were used in 31 cases. The rate of successful flap transfer was 97.7% (126 of 129 free flaps). There were 4 cases of partial flap necrosis.
CONCLUSION: The microvascular free flaps can provide several versatile flaps for the complex anatomy of the head and neck region and achieve the goal of reconstruction functionally and aesthetically. Otolaryngologists have abundant experience and expertise in anatomy and physiology of the head and neck. After special microvascular surgery training, otolaryngologists can perform microsurgical reconstruction of the head and neck.

並列關鍵字

free flap reconstruction ； head and neck reconstruction