Free Scapular Osteomusculocutaneous Flap for Frontal Sinus Infection Complicated with Osteomyelitis- Report of Two Cases

合併大圓肌之肩胛骨自由皮瓣轉移應用於額竇感染併發骨髓炎之重建應用－病例報告

吳泰漳(Tai-Chang Wu) ； 蕭弘道(Hung-Tao Hsiao) ； 董光義(Kwang-Yi Tung) ； 林仲樞(Chung-Shu Lin)

《中華民國整形外科醫學會雜誌》 11卷3期 (2002/09) Pp. 209-219

https://doi.org/10.7096/JPSA.200209.0209

摘要

對頭頸部的外傷而言，額竇骨折並不罕見，約佔顏面骨骨折的百分之五至百分之十二左右。處理的原則主要是著重在骨折嚴重程度以及鼻額管是否受侵犯而做決定。如果處理不慎，可能造成額竇炎、黏液囊腫、腦膜膿瘍、腦膜炎、骨髓炎，甚至造成顏面外觀受損等等的後遺症。因外傷造成額竇骨折術後，產生額竇感染併骨髓炎的併發症，標準處理原則包括廣泛清除壞死骨頭以及需要富含血液循環的健康組織來填充額竇缺損，如果同時重建顏面外觀，可以減少病人接受第二次手術的痛苦。自從腓骨自由皮瓣廣泛被應用以來，肩胛骨自由皮瓣的使用益發減少，然而，因為特殊的大體解剖的關係，肩胛骨自由皮瓣可以合併皮膚、皮下組織、筋膜、肌肉或骨頭取下來，可以滿足額竇感染併骨髓炎重建的需求。我們報告二例個案，成功轉移合併大圓肌之肩胛骨自由皮瓣，同時解決額竇嚴重感染以及重建顏面外觀缺損，得到滿意的結果，這種皮瓣，可以當做另一種重建方法的選擇。

並列摘要

Frontal sinus fractures comprise only % to 12% of all fractures of the maxillofacial skeleton. Most often, they result from a high-energy impact to the upper third of face. Fracture of the frontal sinus secondary to head trauma may lead to serious complications, including frontal sinusitis, meningitis, mucocele, pyomucocele, brain abscess, osteomyelitis, and frontal contour defects. The objectives of treatment are the elimination of any factors predisposing to infection, the restoration of normal sinus function, and repair of the cosmetic deficit. The scapular osteocutaneous free flap has lost its popularity after the introduction of free fibular and iliac osteocutaneous flaps. However, its reconstructive potential remains greater than that of other bone flaps, making it perhaps the most versatile flap used in head and neck reconstruction. This design permits the reconstruction of extensive defects or the use of different tissues for specialized coverage. The presence of chronic osteomyelitis requiring debridement of all devitalized tissue and necrotic bone and replacement with healthy, well vascularized tissue, followed by treatment of the bone defect. The free scapular osteomusculocutaneous flap contains wellvascularized muscle and bone, and has been shown to resolve frontal sinus infection with osteomyelitis of frontal sinus wall and simultaneously provide sufficient contour and rigidity to the forehead. We present two cases of frontal sinus infection with osteomyelitis that were successfully reconstructed by using a free scapular osteomusculocutaneous flap. Complete eradication of the disease was achieved, without recurrence. Follow-up at 8 years revealed that the overall aesthetic and functional outcomes were excellent.

並列關鍵字

frontal sinus fracture ； osteomyelitis ； free scapular flap