Posteromedial Thigh Flaps as an Alternative Method for Reconstruction of Recurrent Head and Neck Defect after Ablation

用後內側大腿皮瓣當作頭頸癌復發切除後重建之選擇

張兆瑋(Chao-Wei Chang) ； 賴昕隄(Hsin-Ti Lai) ； 張智豪(Chih-Hau Chang) ； 吳益嘉(Yi-Chia Wu) ； 賴春生(Chung-Sheng Lai) ； 林幸道(Sin-Daw Lin) ； 郭耀仁(Yur-Ren Kuo)

《臺灣整形外科醫學會雜誌》 29卷2期 (2020/06) Pp. 84-96

摘要

Background: Free tissue transfers have become the standard procedures for head and neck reconstructions after cancer ablations. The anterolateral thigh flap (ALT) reconstruction becomes the workhorse flap for reconstruction of head and neck region. However, it is still a major challenge to choose an alternative flap for the patient with resection of recurrent head and neck cancer and its subsequent reconstruction when the ALT flap has been used. Aim and Objectives: The aim of this study is to evaluate whether the posteromedial thigh (PMT) flap with perforators originating from profunda femoris artery could be an alternative choice for reconstructing the recurrent defects after head and neck cancer ablation. Materials and Methods: Ten patients who underwent PMT reconstruction surgery from 2017 to 2019 at Kaohsiung Medical University Chung-Ho Memorial hospital were enrolled in this study. Diagnoses of head and neck cancer, severe fibrosis or flap necrosis were indicated to this study. Furthermore, the PMT flaps were harvested meticulously, and the anastomoses were done to various recipient vessels in end-to-end or end-to-side fashions depending on different situations. Results: Ten patients with eight different oral cancers, one dysplasia, one flap failure, and one previous flap partial necrosis were enrolled in our series. Eleven PMT flaps were used for reconstructions. Nine patients were male, and one patient was female. The flap success rate was 100%, except for one thrombus formation which was salvaged successfully. The primary closure rate of donor site was 91% under normal skin tension without postoperative dehiscence Conclusion: The PMT flap serves a good alternative choice in recurrence of head and neck reconstruction. The perforator locations are consistent and the length of pedicle is reliable. The scar can be easily concealed in the medial thigh and the donor site can be primarily closed uneventfully in all our cases.

關鍵字

posteromedial thigh flap ； anterolateral thigh flap ； head and neck reconstruction

並列摘要

背景：在頭頸癌重建手術中，自由組織轉移是一個標準的手術，而前外側大腿皮瓣更是在這個重建領域的主力。然而，對於那些頭頸癌復發後進行切除，且該皮瓣已經被使用過的病人來說，選擇何種替代的皮瓣仍然是一個挑戰。目的及目標：此篇文章的目的，在於評估血管供應起源於深股動脈之後大腿內側皮瓣，是否能在復發之頭頸癌的病人進行切除後重建時，可提供一個替代的皮瓣選擇。材料及方法：此篇論文收集在高雄醫學大學附設中和紀念醫院從2017年至2019年總共十位使用後內側大腿皮瓣重建手術之病人，這些病人診斷包括頭頸癌、嚴重沾黏、或者皮瓣壞死。進行重建時，後內側大腿皮瓣會被仔細地取下來，並且依據不同的狀況，採取不同的接血管方式。結果：在這十位病人當中，總共十一次使用後內側大腿皮瓣，其中有八次手術是診斷為不同之癌症、一次是不典型增生、一次是之前皮瓣全失敗、一次是之前部分皮瓣失敗。使用後內側大腿皮瓣成功率為百分之百，其中有一次皮瓣有血栓問題但有成功救回。有九成一的病人其取皮處可以行無張力直接縫合，且術後都沒有發生傷口裂開問題。結論：在頭頸癌復發且需要重建之病人，後內側大腿皮瓣其穿通支之位置都很固定，且其血管蒂長度也很都足夠，可以作為一個很好的皮瓣替代方案。且術後大部分取皮處可以直接縫合，疤痕也會藏在大腿內側而不易被看見。