The Method of A Free Chimeric Anterolateral Thigh Flap (CALT) for Reconstruction of A Through and Through Defect of Buccal Cancer with Oral Commissure Involvement

自由變異前外側股皮瓣使用於口腔癌穿透性臉頰缺損併嘴角侵犯的重建方法

蔡豐州(Feng-Chou Tsai) ； 黃維超(Wei-Chao Huang) ； 陳宏基(Hung-Chi Chen)

《中華民國整形外科醫學會雜誌》 10卷1期 (2001/03) Pp. 50-58

https://doi.org/10.7096/JPSA.200103.0010

摘要

口腔癌穿透性臉頰缺損併嘴角侵犯的重建通常相當困難，畢竟其牽涉到許多不同組織構造的重建。雖然有各種不一樣的重建方法如根蒂皮瓣，但其僅能解決有限的問題並且會造成美觀的妨礙。故基於自由變異前外側股皮瓣具有表皮較薄，血管較長，解剖位置固定，可作各式各樣的變異設計等優點，我們使用之，並將皮瓣分割為兩塊，做為口腔內及臉頰缺損的覆蓋，同時重建嘴角以維持嘴唇的功能與形狀，而肌肉部分則用以填滿頰部，並以經改良和後遣症較少的取得皮瓣方法，來達到兼顧外觀及功能的雙重目的。

並列摘要

Reconstruction of the through and through buccal cancer defect is difficult because of the three-dimensional loss of tissue. The various kinds of reconstruction including pedicled flaps can solve a limited number of problems, but still leave an aesthestic disability. Therefore there are a lot of advantages of free flaps, especially chimeric anterolateral thigh (ALT) flaps. In this paper, we describe the anatomy of the cutaneous perforators of the ALT flap, and the technical refinement to harvest CALT flaps, as well as the reconstruction of the mouth angle for through and through defects in the head and neck regions in detail. The size of through and through defect with oral commissure involvement was 5×14 cm^2 in this case. The size of flap larger than the defect was 6×16cm^2. The flap was separated to 6×10cm^2 proximally, and 6×6cm^2 distally for the cheek defect and the intra-oral lining according to the position of perforators. The recipient artery and vein was superior thyroid artery and a branch of internal jugular vein respectively. The vastus lateralis muscle and fascia was used for the restoration of cheek volume and mouth angle sling. The flap survived well postoperatively. In the clinical follow-up, the patient obtained adequate oral continence, deglutition and resumed a solid diet. The aesthetic result was acceptable after 6 months.

並列關鍵字

anterolateral thigh flaps ； buccal cancer ； chimeric design ； oral commissure