Facial Contour Restoration Using a Free De-epithelialized Groin Flap-A Case Report

口腔癌病患經手術及放療後以游離去上皮鼠蹊皮瓣行外觀重建－病例報告

黃雯琪(Wen-Chi Huang) ； 蕭弘道(Hung-Tao Hsiao) ； 董光義(Kwang-Yi Tung)

《臺灣整形外科醫學會雜誌》 20卷2期 (2011/06) Pp. 142-147

https://doi.org/10.7096/TJTSPS.201106.0142

摘要

背景：
以游離皮瓣行面部外觀之重建爲現今常見之術式，西元一九七八年即有游離去上皮鼠蹊皮瓣行面部重建之報告，而各式去上皮游離皮瓣亦陸續發展。近年來去上皮之大腿前外側脂肪筋膜皮瓣也有諸多研究報告。
目的及目標：
我們報告一例以游離去上皮鼠蹊皮瓣爲口腔癌病患經放療後產生疤痕攣縮之面部外觀進行美容重建，並回顧文獻研究，提供相關之經驗。
材料及方法：
一位四十六歲男性右側齒齦鱗狀細胞癌病患已接受游離腓骨皮瓣重建，並於放射線治療後出現明顯右側下頷區域軟組織缺乏及部分疤痕攣縮。游離去上皮鼠蹊皮瓣被選擇爲外觀重建之材料，並定位出先前游離腓骨皮瓣之供應血管做爲新皮瓣血供之來源。游離皮瓣之尺寸及形狀依照疤痕攣縮部位而設計。
結果：
游離去上皮鼠蹊皮瓣術後情形良好，無其他併發症。外觀亦令人滿意。
結論：
對口腔癌病患行外觀重建的手術而言，技術本身簡單但完善的術前評估困難，且組織缺損體積尺寸均不一，造成選擇適當皮瓣的複雜性。我們認爲依T. Mucke等人的研究看來，術後18個月做爲提供口腔癌病人行面部外觀重建前之的觀察期爲一適當的做法。除此之外，以我們所提出之方法，游離去上皮鼠蹊皮瓣可以提供此類外觀重建病患許多好處及更多選擇。

並列摘要

Background:
Reconstruction of facial deformity using free flaps is a common practice, and various de-epithelialized free flaps have been reported. Free de-epithelialized groin flap dates back to 1978. Nonetheless, free anteriorlateral thigh adipofascial flaps are adopted more frequently nowadays.
Aim and Objectives:
We present a case of facial asymmetry due to soft tissue loss following surgery and irradiation for oral cancer. The facial contour was reconstructed using a free deepithelialized groin flap.
Materials and Methods:
A 46-year-old man diagnosed with gingival squamous cell carcinoma underwent hemimandibulectomy with radical neck dissection and free fibular osteocutaneous flap reconstruction nineteen months prior to second reconstruction. Significant soft tissue defect and limited neck motion were observed after radiation therapy. A free de-epithelialized groin flap was designed with a bilobe pattern in the tail. The peroneal artery and vein of the previous fibular flap were used as recipient vessels. With the dermis side up, the flap was fixed with buried absorbable sutures and stay sutures.
Result:
The postoperative course was uneventful. A satisfactory aesthetic and functional result was obtained after six months of follow-up.
Conclusion:
A free de-epithelialized groin flap can be a good option for restoration of facial contour in patients with oral cancer and facial deformity. Our case highlights the complexity and considerations of flap selection during reconstruction.

並列關鍵字

De-epithelialized free groin flap ； oral cancer ； reconstruction ； face contour restoration