Using Three Free Flaps for Reconstruction of an Advanced Head and Neck Cancer Patient

利用三塊自由皮瓣重建頭頸部巨大腫瘤術後缺損之病例報告

蘇皇銓(Huang-Chuan Sue) ； 蕭弘道(Hung-Tao Hsiao) ； 董光義(Kwang-Yi Tung)

《臺灣整形外科醫學會雜誌》 19卷1期 (2010/03) Pp. 85-94

https://doi.org/10.7096/TJTSPS.201003.0085

摘要

背景：
目前仍有部份罹患頭頸部腫瘤的病人因為害怕而拒絕接受手術，但時間的延遲易使手術的難度增高，尤其是重建的部份。在切除巨大腫瘤後，通常需要利用一塊以上的皮瓣來重建，若接受區無適當的血管，自由皮瓣手術的失敗率也會相對提高。
目的及目標：
在巨大的頭頸部腫瘤切除後，常常合併多種組織及器官缺損。整形外科醫師必須利用重建的方式來恢復其外觀及功能。
材料及方法：
此37歲男性病人罹患口腔底部惡性腫瘤，因害怕手術轉而接受四次化學治療，但成效不彰。一年後，因腫瘤大量出血而住院治療。在評估腫瘤分期後，實行腫瘤切除及兩側頸部淋巴結擴清術，我們利用三塊自由皮瓣；腸皮瓣、腓骨骨皮瓣、前外側大腿肌肉皮瓣來重建缺損處。因頭頸部接受區無適當的血管，故利用皮瓣血管莖與左總頸動脈及左內頸靜脈作端對邊的血管吻合。
結果：
三個自由皮瓣完全存活，術後四週可食用流質飲食，外觀及功能病人可接受。
結論：
我們成功地利用三塊自由皮瓣來重建頭頸部大範圍缺損，其血液供應來自皮瓣血管莖和頸部大血管作端對邊的吻合。另外，利用相似的組織特性來重建，如空腸段來重建食道，也符合吞嚥的生理功能。

並列摘要

Background:
At present, there are still some head and neck cancer patients who refuse surgery because of fear. However, delayed treatment makes the operation more difficult, especially reconstructive surgery. After en bloc resection of an advanced head and neck cancer, the defect usually needs more than one flap to reconstruct. Moreover, if the recipient vessels are unavailable, high failure rates of free tissue transfer often bother reconstructive surgeons.
Aim and Objectives:
Complex head and neck defects after oncologic resections often require composite reconstruction of mucosal lining, skeletal support and soft tissue coverage. The reconstructive goals are restoration of the basal oromandibular function and socially acceptable appearance.
Materials and Methods:
A 37-year-old male patient was diagnosed with mouth floor squamous cell carcinoma. However, due to fear of surgery, he refused to undergo operation and switched into take four times of chemotherapy, but they were ineffective. One year later, he was admitted because of massive tumor bleeding. After initial assessment, he underwent en bloc tumor resection and bilateral modified radical neck dissection. The branches of the neck major vessels were almost ligated. The defect was then reconstructed with three free flaps including a jejunal flap, a fibular osteocutaneous flap and an anterolateral thigh (ALT) myocutaneous flap. Because the recipient vessels in the neck were unavailable, we utilized end-to-side microvascular anastomosis to overcome the difficulty.
Results:
Postoperatively, all flaps survived and the patient was recovering and doing well. At four weeks of follow-up, liquid diet was tolerated and he was satisfied with the result.
Conclusion:
We successfully used three free flaps with end-to-side microvascular anastomosis to reconstruct an extensive head and neck defect in a vessel-depleted neck. Moreover, the nature of the defect clearly dictates the method of reconstruction; for example, it is ideal to reconstruct the hypopharynx and cervical esophagus with a free jejunal flap to serve as a conduit and get a good swallowing function.

並列關鍵字

advanced head and neck tumor ； three free flaps ； end-to-side microvascular anastomosis ； microsurgery