游離橈前臂皮瓣於口內環境下之臨床以及組織變化－病例研究

Clinical and Histological Changes of a Free Radial Forearm Flap Transplanted into the Oral cavity-A Case Study

胡廣煜(Kwang-Yung Hu) ； 林秉毅(Ping-Yi Lin) ； 吳大維(Da-Wei Wu) ； 章浩宏(Hao-Hueng Chang) ； 郭英雄(Ying-Shiung Kuo) ； 藍萬烘(Wan-Hong Lan)

《中華牙醫學雜誌（中文版）》 1卷1期 (2005/03) Pp. 54-60

https://doi.org/10.7106/CJD.200503.0054

摘要

在頭頸部的腫瘤中，舌癌在台灣口腔癌發生率中，佔有相當高的比例。而且舌頭不管在發音、吞嚥、協助咀嚼，味覺等方面均扮演極重要的角色。利用顯微游離皮辦來作為舌癌切除後之重建已經越來越普遍，而游離橈前臂皮瓣(free forearm flap)是最常應用的方式之一。雖然此皮瓣已被廣泛應用，但對癒合之過程仍有爭議及未解之處，過去的研究發現利用游離橈前臂皮瓣(forearm flap)重建舌體後，臨床追蹤發現游離皮辦在口內的環境下，其皮瓣的色澤(color)與質感(texture)均有改變，且從肉眼上觀察具有紅化(reddened)的現象，與正常口腔黏膜相似。本報告提出一61歲男性舌癌病例，病人於2003年10月25日接受部份舌切除術及左側改良式全頸部淋巴結清除術，採用左手前臂游離橈動脈皮瓣重建，術後研究皮瓣在口內環境下，組織以及臨床上的變化，發現皮瓣仍保有原本表皮(epidermis)的四層結構，只見表皮層(epidermis)變厚及具有較深的上皮棘(rete ridges)。表皮層內發現棘皮層增生(acanthosis)的現象與不明顯的角質層。此類似口腔黏膜、紅化的現象，其原因可能是由於慢性發炎的刺激，如口水分泌物，造成真皮層(dermis)的慢性發炎所致。

關鍵字

游離橈前臂皮瓣 ； 黏膜化

並列摘要

Among cases of head and neck neoplasms, the occurrence of a tongue squamous cell carcinoma (SCC), comprised a higher percentage in Taiwan. The tongue plays an important role in pronunciation, swallowing, mastication and taste. Because of a poor prognosis of tongue SCCs, wide excision and reconstruction are very important issues. A free flap is recommended for reconstruction according to the concerns of function, esthetics, and wound healing. This article reports a case of a 61-year-old patient with Soc of tongue who had undergone a left free radial forearm flap reconstruction operation after a partial glossectomy and left modified radical neck dissection. Postoperatively 1 month, the flap had changed color and texture under naked-eye inspection, and resembled the oral mucosa. Clinically and histologically, the subcutaneous fat in this case was considerably thinner, and the results showed the redness of the flap to be a normal inflammatory reaction. True mucosal metaplasia was not observed. The reddened flap maintained the structure of the epidermis. A thickened epidermis and deepening rete ridges could still be observed. Acanthosis and imperceptible stratum corneum have also been discovered within the epidermis. The redness is related to the degree of dermal inflammation and telangiectasia. The redness may be the result of exposure of the forearm skin to oral secretions.

並列關鍵字

free forearm flap ； mucosalization