- 期刊
Management of Skin Paddle without Visible Sizable Perforator in the Fibula Osteoseptocutaneous Flap for the Mandibular Reconstruction after Cancer Ablation-Two Cases Report
以腓骨皮瓣組織重建口腔癌術後合併下頜骨缺損而皮瓣組織無明顯血管穿通枝供應的臨床治療經驗－兩個病例報告
摘要
腓骨皮瓣其皮瓣組織的血流供應可信度仍具爭議性，大部份作者在摘取腓骨皮瓣時，其面臨無肉眼明顯可見大小的血管穿通枝常建議立刻移除皮瓣組織。然而我們提出兩例因口腔癌合併下頜骨切除須利用腓骨皮瓣重建口腔黏膜及下頜骨缺損，但無明顯穿通枝病例（其皮瓣大小12×4公分及10×5公分），雖然皮瓣組織無明顯良好血液循環供應，但帶血管莖腓骨則血液供應良好。因此這皮瓣仍將其摘取下來，利用保守療法，將皮瓣作口腔黏膜缺損覆蓋，以避免口水堆積在帶血管莖腓骨周圍。而皮瓣組織在兩周後逐漸壞死，我們逐步清創摘除壞死組織，發現其帶血管莖腓骨上其口腔黏膜上皮傷口逐漸自然癒合完成，以及無骨板內固定暴露，並且不須再進一步重建或植皮手術。
關鍵字
無資料並列摘要
The reliability of the fibula osteocutaneous flap is still controversial. Most authors suggested discarding the skin paddle immediately when the harvested skin paddle lacks sizable perforators. Herein, we report two cases without sizable perforator of skin paddles of the fibula osteocutaneous flaps (skin paddle 12×4 and 10×5 cm in size) for mandibular and buccal defects reconstruction. Although not well vascularized, the skin paddle was retained for intraoral lining temporarily on a wait and see policy, and served as a biological barrier to prevent the salivary from pooling around the vacularized bone graft. The skin paddle was removed two weeks later due to complete devascularization. Spontaneous mucosalization developed to resurface the fibula bone graft uneventfully; no further reconstruction was needed.
延伸閱讀
- Lin, Y. T., & Chang, S. H. (2017). 腓骨游離皮瓣於下顎骨重建手術之改良應用. 臺灣整形外科醫學會雜誌, 26(3), 262-273. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-201709-201709280010-201709280010-262-273
- Su, Y. P., Leung, K. W., Chen, J. S., Chen, L. W., Hsu, K. C., Liu, W. C., Lin, Z. D., & Yang, K. C. (2011). 雙重口腔癌腫瘤切除後使用單一具有二個皮板的游離腓骨骨肌皮瓣重建口腔及下頜骨. 臺灣整形外科醫學會雜誌, 20(2), 120-128. https://doi.org/10.7096/TJTSPS.201106.0120
- Yang, Y. H., Shih, H. S., Feng, G. M., Chen, J. A., & Jeng, S. F. (2016). 用腓骨自由皮瓣作下顎骨立即性與延遲性重建的皮瓣存活率比較. 臺灣整形外科醫學會雜誌, 25(4), 314-329. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-201612-201701130018-201701130018-314-329
- Chu, H. C., Chen, S. G., Shieh, Y. S., Wang, Y. B., Yu, T. C., & Chen, Y. W. (2015). 利用腓骨游離骨皮瓣重建嚴重外傷所致下顎骨缺損－病例報告. 中華民國家庭牙醫學雜誌, 10(3), 45-50. https://doi.org/10.6566/JFD/2015.10(3).45
- 蔡啟穎、張陽明、魏福全、林敬凱（2005）。腓骨肌皮瓣加上金屬關節頭重建廣泛切除之復發性下顎造釉細胞瘤－病例報告。中華民國口腔顎面外科學會雜誌，16(1)，74-81。https://doi.org/10.7104/CJOMS.200503.0074