合併肩胸皮瓣及顳肌瓣重建頰癌術後缺損－病例報告

Reconstruction with Deltopectoral Flap and Temporalis Muscle Flap for the Surgical Defect of Buccal Cancer

陳世偉(Shih-Wei Chen) ； 李正喆(Jen-Jehr Lee) ； 郭正興(Sang-Heng Kok) ； 郭英雄(Ying-Shiung Kuo) ； 楊博正(Puo-Jen Yang) ； 韓良俊(Liang-Jiunn Hahn)

《中華民國口腔顎面外科學會雜誌》 8卷1期 (1997/03) Pp. 19-25

https://doi.org/10.7104/CJOMS.199703.0019

摘要

近年來由於檳榔消費增加，導致臺灣口腔癌病例大幅增長，其中頰癌僅次於舌癌，佔口腔癌病例的第二位。而頰癌癌細胞常往深部組織浸潤，甚至造成頰部皮膚穿孔。由於手術時須全層頰部切除，而造成重建上的困擾。近年雖有自由肌皮瓣的修補應用，但是常造成手術時間延長，且須靠整型外科醫師合作，因此傳統式的局部皮瓣仍有其應用價值。各式皮瓣手術因特性不同，各有其優缺點及適應症。其中顳肌瓣因厚薄適中，柔軟易曲，上無毛髮，接近口腔，而且術後除了顳部略為凹陷外，下顎之運動與功能均可維持，故特適用於口内重建。而肩胸皮瓣因取得容易，面積廣大，壞死率低，不會破壞胸部外形及運動功能，適合重建口内黏膜和口外肌膚。過去曾有學者分別提出單獨以顳肌瓣或肩胸皮合併皮膚移植，來重建頰部缺損；我們則首先嘗試以顳肌瓣合併肩胸皮瓣雙層重建頰部缺損。本文將就手術方法、後遺症及術後追蹤提出二例病例報告，二例皆為T3N1M0，stage Ⅲ的頰癌病患，接受頰部全層切除及合併肩胸皮瓣和顳肌瓣修復頰部缺損，無論在功能或是外觀方面都達到令人滿意的程度，至今仍在門診追蹤治療中。

關鍵字

顳肌瓣 ； 肩胸皮瓣 ； 頰癌 ； 重建

並列摘要

The incidence of oral cancer keeps increasing as the consumption of betel nut is increasing these years in Taiwan. Among all oral cancers, the incidence of buccal cancer took the second place, just below the tongue cancer. The buccal cancer usually causes deep infiltration of tissues, furthermore, perforation of the skin of the cheek. Therefore, the operation should include the wide excision of the cheek in full thickness, which is so ablative that it is hard to reconstruct the surgical defect. Recently, the application of free thssue transfer is helpful for reconstruction of the defect, but the microsurgery is mandatory and the operation time is doomed to prolongation. Therefore, the regional flaps are valuable in some circumstances. There are different indications and contraindications between the flaps because of their anatomy and tissue components. For the temporalis muscle flap has ideal bulk, flexibility, durability, and proximity to the oral cavity, it is quite suitable for reconstruction of buccal defect. Moreover, it provides non-hair-bearing surface and the use of this flap does not impair the function of mandible. The advantages of deltopectoral flap are easy surgical technique, sufficient surface dimension, and low post-operation morbidity. In the past, the use of these two flaps individually for reconstruction of intraoral defect has been documented many times. In a series of two patients with buccal cancer, we used temporalis muscle flap in conjunction with deltopectoral flap for reconstruction of buccal defect. We have a discussion of the surgical techinque, complication, and post-operative follow-up.