鎖骨上動脈島狀皮瓣在頭頸部腫瘤手術重建時的另一選擇

The Supraclavicular Artery Island Flap: An Alternative in Head and Neck Reconstruction

王誌群(Chih-Chun Wang)

指導教授 ： 王照元

高雄醫學大學/醫學院/臨床醫學研究所/碩士(2015年)

摘要

運用鎖骨上動脈島狀皮瓣重建頭頸部腫瘤手術後組織缺損，並探討其可行性。採
回溯性分析，蒐集2014年6月至12月間曾在義大醫院耳鼻喉部接受鎖骨上動脈島狀皮瓣以重建頭頸部組織缺損的病患為研究對象，整理分析其臨床資料，包括：性別、年齡、腫瘤部位及缺損部位、皮瓣大小、淋巴廓清與否、放射治療與否、皮瓣存活率及術後之皮瓣相關併發症。
共12位病人：11位男性，1 為女性；年齡分佈為45歲至73歲，平均55歲；其中8位為下咽癌病患，2位為口腔癌病患，1位為喉癌病患，1位為深頸部感染病患。8位下咽癌病患中，其中6位接受部分咽喉切除手術，2位接受全咽喉切除手術。皮瓣平均大小為6.5公分寬，11公分長。12位病患，術後追蹤至今，全部病患的鎖骨上動脈島狀皮瓣均存活。3位下咽癌病患則發生皮瓣邊緣處部分壞死，須以胸大肌皮瓣或胃上拉(gastric pull up)的方式進行救援手術。一位口腔癌病患則因頸部皮瓣隧道處有滲漏而影響皮瓣供皮區的癒合，曾接受供皮區清創手術。
鎖骨上動脈島狀皮瓣在頭頸部腫瘤手術的重建上，提供了另一理想的選擇；然而，對於需廣泛淋巴廓清及頸部接受過放射治療之病患，由於可能會傷及橫頸動脈的血液供應，此一皮瓣的引用，應謹慎選擇。

關鍵字

鎖骨上動脈島狀皮瓣 ； 頭頸部腫瘤手術重建

並列摘要

BACKGROUND: The supraclavicular artery island flap, an alternative to traditional regional or free flap, is gradually successfully used in head and neck reconstruction of various kinds of head and neck defects.

METHODS: From June 2014 to December 2014, 12 patients who underwent head and neck surgery with the supraclavicular artery island flap reconstruction at E-Da hospital were enrolled in this study. The demographic data, clinical presentation, flap design, complication as well as functional outcome of each patient were retrospectively collected and analyzed.

RESULTS: These 12 patients (11 men and 1 women), aged 45-73 years, underwent supraclavicular artery island flap reconstruction immediately following the head and neck tumor resection. The surgical defects included pharynx (8), oral cavity (1), tracheal-stoma (1), and neck or face (2). The dimension of the flap was averagely 6.5cm x 11cm. The overall flap survival rate was 100%. 3 patients experienced partial skin loss and were rescued by the pectoralis major myocutaneous flap or gastric pull-up surgery. 1 patient experienced the donor site minor wound dehiscence and received further debridement.

CONCLUSIONS：The supraclavicular artery island flap is a reliable alternative in head and neck reconstruction. Neck dissection (level IV or V) or radiation history can compromise the blood supply of the supraclavicular island flap and may impede the choice of this flap.

並列關鍵字

Supraclavicular Artery Island Flap ； Head and Neck Reconstruction

參考文獻

1.Lamberty BG: The supraclavicular axial patterned flap. Br J Plast Surg 1979, 32: 207-212.

2.Khouri RK, Ozbek MR, Hruza GJ, Young VL: Facial reconstruction with prefabricated induced expanded supraclavicular skin flaps. Plast Reconstr Surg 1995; 1007-1015.

3.Mizerny Br, Lessard ML, Black MJ: Transverse cervical artery fasciocutaneous free flap for head and neck reconstruction: initial anatomic and dye studies. Otolaryngol Head Neck Surg 1995; 113:564-568.

4.Pallua N, Machens HG: The asciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997; 99: 1878-1884.

5.Abe M, Murakami G, Abe S, Sakakura Y, Yajima T: Supraclavicular artery in Japanese: an anatomical basis for the flap using a pedicle containing a cervical, non-perforating cutaneous branch of the superficial cervical artery. Okajimas Folia Anat Jpn 2000; 77: 149-54.