頭頸部同時雙自由皮瓣重建之應用

口腔癌患者的治療除了腫瘤的切除外，還有重建缺損的部分，以期能改善患者術後功能與增進生活品質。一個侵犯範圍較廣的腫瘤，通常意指範圍更大的組織切除。面對如此大的複合性組織缺損：包括顏面皮膚、口腔黏膜、肌肉、脂肪、上下顎骨等，同時雙自由皮瓣重建會是一個解決方式。我們回溯性研究從2001年二月至2014年八月治療342位口腔癌患者，使用了386片自由皮瓣。這些口腔癌患者有41位患者至少接受過兩片或兩片以上的自由皮瓣治療，其中有28位患者因為臉部大範圍的複合性組織缺損而使用同時雙自由皮瓣重建。大範圍複合性組織缺損為包括外部皮膚、內部口腔黏膜、區段性下顎骨缺損，有時更擴及軟顎、上顎骨、咽壁、唇部等。28位接受同時雙皮瓣重建的口腔癌患者，3位病理分期為第三期，其餘為第四期。8位接受腓骨皮瓣加上橈側前壁皮瓣，20位使用腓骨皮瓣加上前外側大腿皮瓣。外側覆蓋面積為95.62cm^2（30-132），而內側覆蓋面積為102.92 cm^2（56-150）。腓骨使用長度平均為15.1公分（12-20）。平均麻醉時間為19.8小時而皮瓣失敗率為3.5%－兩片腓骨自由皮瓣因為動脈栓塞而失敗。再探查機率為10.7%：五個案例因為靜脈血栓，一例因為動脈栓塞。沒有患者死於術後併發症。平均的追蹤時間為42.4個月，64%患者依舊存活。對於死亡案例，平均存活時間為術後19個月。對於頭頸部大範圍的組織缺損，同時雙皮瓣重建是一個很好且適當的解決辦法。此方法不但能覆蓋大範圍的暴露組織，還可以有三度空間的重建，對於複雜功能性部位的重建也有很好的效果，如嘴角，唇部等重建。

關鍵字

同時雙自由皮瓣；自由皮瓣重建；口腔癌

並列摘要

Introduction: Oral cancer is a disastrous disease. Patients with oral cancers tolerate not only facial deformity but also loss of many essential functions, such as chewing, swallowing, speaking and tasting. The more advanced the disease imply more tissue needs to be sacrificed. Large composite defects on the face and oral cavity appear after the lesion is radically excised. When we face this extensive composite defects, simultaneous double free flap technique can be a good option. Materials and Methods: This is a retrospective study. The patients' data was reviewed from the computer database of St. Martin De Porres hospital. From February 2001 to August 2014, 342 oral cancer patients were treated utilizing 386 free flaps in total. Of these, 28 patients received simultaneous double free flap reconstruction due to extensive composite defects on their maxillofacial regions. The definition of the extensive composite defect is, at least, the loss of facial skin, oral mucosa, and segmental mandible and sometimes is combined with soft palate, maxilla, pharyngeal wall or lip defects after tumor resection. The defects obviously could not be reconstructed utilizing only one free flap, and therefore the double free flap technique was performed. Results: Of the 28 double free flap reconstructions, 3 patients were in stage III and 25 were in stage IV of oral squamous cell carcinoma. 8 cases received fibula plus radial forearm free flaps, whereas 20 cases received fibula plus anterolateral thigh free flaps. The mean dimension of the outer lining was 95.62 cm^2 (30-132), while the inner lining measured 102.95 cm^2 (56-150). The mean length of the harvested fibula bone was 15.1 cm (12-20). The mean anesthesia time was 19.8 hours. The flap failure rate was 3.5%, as two fibula flaps failed due to artery thrombosis. The re-exploration rate was 10.7%: 5 cases were due to venous thrombosis, and the other one was due to artery occlusion. No patients died of postoperative complications. The mean follow up time was 42.4 months and 64% of the patients are still alive as at their last visits. For the expired cases, the mean survival time was 19.0 months after the operation. Conclusion: For extensive composite defects of the face and neck, two free flaps could be the best combination for reconstruction. Double free flaps not only cover large raw surface areas, but can also be used to rebuild the three-dimensional and highly functional facial profile.

並列關鍵字

Simultaneous free flap ； Free flap reconstruction ； Oral cancer

國際替代計量

頭頸部同時雙自由皮瓣重建之應用

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