前臂橈側皮瓣應用於頭頸部重建之經驗

The Experience of Radial Forearm Flap Used in Head and Neck Reconstruction

郭文宏(Wen-Hong Kuo) ； 陳明庭(Ming-Ting Chen) ； 洪學義(Shyue-Yih Horng) ； 羅啓華(Chi-Hua Lo)

《中華民國重建整形外科醫學會雜誌》 4卷2期 (1995/06) Pp. 103-110

https://doi.org/10.7096/JPRSA.199506.0103

摘要

台大醫院自1980年代後期間始用前臂橈側皮瓣進行頭頸部術後的重建。近五年來，又整形外科與耳鼻喉科合作，向耳鼻喉科醫師先行頭頸部腫瘤的切除，再由整形外科做術後的重建。本篇統計自1989年5月至1993年2月間以前臂橈側皮瓣做頭頸部術後重建的病人共31例。男性28人，女性3人，平約年齡為50.5 歲。除一例失敗外，手術成功率為97%。其中一例為嚴重峰窩組織炎，其餘皆為癌症病患。並沒有急者因手術造成手部活動的重大影響。
歸納出前臂橈側皮瓣的優點包括有：1．一次手術，2．輕薄且可塑性高，3．容易做術前評估，4．可與口腔內手術同時進行， 5．取得吻合皆容易，6．可依需要而設計，7．不影響舌頭的活動，8．可做同側或對側的吻合，9．可做內面及外部的覆蓋，10．相當可靠，11．疼痛度低，12．併發症少，13．美觀上可被大多數患者所接受，並在術後可以放心接下去做放射線治療，不但沒有傷口暴裂的病例，經放射治療後之皮瓣周圍較為平坦沒有周圍變形(Trap door deformity)發生。對口腔內之皮瓣如經放射線治療後表皮之鱗狀變異（Squamous metaplasia類粘膜性變化）不易發生，故表皮細胞會維持原來的皮膚色而不會粘膜化。它的缺點是供瓣處（手臂）的缺陷比較難看，需要顯微手術的技巧，若同時取骨頭，可能會造成骨折。由於相對於它的優點，這部分是可以補償和接受的。對於口腔內術後的重建，前臂橈側皮瓣是一個安全、可靠，可廣乏適用於各種情況且方便的方法，相信它未來的應用將會是更多、更廣。

關鍵字

前臂橈側皮瓣 ； 自由皮瓣 ； 裂層植皮

並列摘要

At National Taiwan University Hospital, radial forearm flap is applied for postoperative head and neck reconstruction since late 1980s. This technique provides more radical resection of cancer around oral cavity. We collect 31 consecutive cases from May, 1989 through Feb., 1993 who received forearm flap for head and neck reconstruction with promising results. Only one case has failed with an over all 97% successful rate.
We use it to close the defect at buccal area, mouth floor, pharynx and anterior mouth. The flap can provide an excellent inner and outer lining. 74% of patients had received previous treatments including chemotherapy (26%), radiotherapy (26%) and excision (42%). The donor vessels are radial artery, cephalic vein (48%) and comitant vein (46%). The vessels for anastomosis at recipient site are superior thyroid artery (58%), facial artery (24%), external jugular vein (44%) and superior thyroid vein (19%), 17 patients have two venous anastomosis (55%). There are 8 (26%) cases of major complications that need reoperation including wound infection 3, hematoma 2, venous obstruction 2, bleeding 1. The complications are compatible with the foreign series.
During follow-up, we find that the patients who receive local radiotherapy after operation have no trap door deformity and little squamous metaplasia in intra-oral lining.
In conclusion, radial forearm flap is a thin, pliable, easy performed free flap with reliable vascular pedicle for a variety of reconsturction for head and neck cancer operation and it is particularly useful for intra-oral linings.

並列關鍵字

Radial forearm flap ； Free flap ； Split thickness skin graft ； STSG