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鎖骨上動脈島狀皮瓣在頭頸部手術重建時的另一選擇

The Supraclavicular Artery Island Flap: An Alternative in Head and Neck Reconstruction

摘要


背景:運用鎖骨上動脈島狀皮瓣重建頭頸部腫瘤手術後組織缺損,並探討其可行性。方法:採回溯性分析,蒐集2014年6月至12月間曾在義大醫院耳鼻喉部接受由耳鼻喉科醫師執行鎖骨上動脈島狀皮瓣以重建頭頸部組織缺損的病患為研究對象,整理分析其臨床資料,包括:性別、年齡、腫瘤部位及缺損部位、皮瓣大小、淋巴廓清與否、放射治療與否、皮瓣存活率及術後之皮瓣相關併發症。結果:共12名病人:11名男性,1名為女性;年齡分佈為45歲至73歲,平均55歲;其中8名為下咽癌病患,2名為口腔癌病患,1名為喉癌病患,1名為深頸部感染病患。8名下咽癌病患中,其中6名接受部分咽喉切除手術,2名接受全咽喉切除手術。皮瓣平均大小為6.5 cm寬,11 cm長。12名病患,術後追蹤至今,全部病患的鎖骨上動脈島狀皮瓣均存活。3名下咽癌病患則發生皮瓣邊緣處部分壞死,須以胸大肌皮瓣或胃上拉(gastric pull up)的方式進行救援手術。1名口腔癌病患則因頸部皮瓣隧道處有滲漏而影響皮瓣供皮區的癒合,曾接受供皮區清創手術。結論:鎖骨上動脈島狀皮瓣在頭頸部腫瘤手術的重建上,提供了另一理想的選擇;然而,對於需廣泛淋巴廓清及頸部接受過放射線治療之病患,由於可能會傷及橫頸動脈的血液供應,此一皮瓣的引用,應謹慎選擇。

並列摘要


BACKGROUND: The supraclavicular artery island flap, an alternative to traditional regional or free flap, is gradually successfully used in head and neck reconstruction of various kinds of head and neck defects. METHODS: From June 2014 to December 2014, 12 patients who underwent head and neck surgery with the supraclavicular artery island flap reconstruction by otolaryngologist at E-Da hospital, were enrolled in this study. The demographic data, clinical presentation, flap design, complication as well as functional outcome of each patient were retrospectively collected and analyzed. RESULTS: These 12 patients (11 men and 1 women), aged 45-73 years, underwent supraclavicular artery island flap reconstruction immediately following the head and neck tumor resection. The surgical defects included pharynx (8), oral cavity (1), tracheal-stoma (1), and neck or face (2). The dimension of the flap was averagely 6.5 × 11 cm. The overall flap survival rate was 100%. 3 patients experienced partial skin loss and were rescued by the pectoralis major myocutaneous flap or gastric pull-up surgery. 1 patient experienced the donor site minor wound dehiscence and received further debridement. CONCLUSIONS: The supraclavicular artery island flap is a reliable alternative in head and neck reconstruction. Neck dissection (level IV and/or V) or radiation history can compromise the blood supply of the supraclavicular island flap and may impede the choice of this flap.

被引用紀錄


田昀芳、王琦、吳素蘭、吳金枝、林春吟、陳育宜(2020)。提升手術室護理人員骨腫瘤切除併皮瓣手術護理完整性新臺北護理期刊22(1),73-84。https://doi.org/10.6540%2fNTJN.202003_22(1).0007

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