Modificiation of infrahyoid neuromyocutaneous flap with radical neck dissection.
Modificiation of infrahyoid neuromyocutaneous flap with radical neck dissection.
复制标题
根治性颈清扫术改良舌骨下神经肌皮瓣。
DOI：
10.5455/medarh.2012.66.428-429
复制
发表时间：
2012
期刊：
影响因子：
--
通讯作者：
M. Hassouba
中科院分区：
文献类型：
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作者：
T. Masic;A. Dervišević;E. Babajić;M. Hassouba
介绍
了解皮瓣手术技术可以不折不扣地切除肿瘤并对以前认为无法手术的肿瘤进行手术。舌骨肌神经营养血管肌皮瓣（IHNMCF）是一种以颈部前部为蒂的皮瓣。IHNMCF是一个很好的解决方案，适度大小的头和颈部以下的颧弓。本文的目的是描述改良的舌骨下神经肌皮瓣用于修复舌和口底缺损，肿瘤切除后立即。
病例报告
一位63岁的病人因病理组织学证实的鳞状细胞癌住院。肿瘤位于口腔腹侧区域。头部和颈部的磁共振成像（MRI）和超声检查显示颈部右侧有可检测的淋巴结，颈部左侧有可疑淋巴结。通过经下颌入路，对肿瘤进行了广泛的局部切除。从右侧收获IHNMCF。进行了细致的微血管手术，对右甲状腺上级静脉与左甲状腺上级静脉进行了静脉端对端吻合。患者在手术过程中接受了左侧肩胛舌骨上颈淋巴结清扫术和右侧根治性颈淋巴结清扫术。
讨论和结论
这种改良的舌骨下皮瓣的缺点是旋转弧度非常有限。这严重限制了它的应用，在特定的情况下，缺陷位于非常接近皮瓣。同时，改良皮瓣的优点是根治性颈清扫不再是禁忌症。在这种情况下，皮瓣是成功的，没有皮瓣坏死或并发症的供侧。言语和吞咽无明显下降。放射治疗后皮瓣保持足够的柔软、营养和移动的。
INTRODUCTION
Understanding technique of flap surgery allow uncompromising tumor resection and operation of tumors previously considered inoperable. Infrahyoid neuro-myocutaneous flap (IHNMCF) is pedicled flap harvested from the anterior part of the neck. IHNMCF is a good solution for the moderated sized defects of the head and neck below the zygomatic arch. The objective of this article was to describe modified infrahyoid neuromyocutaneous flap used for reconstruction of tongue and mouth floor defects, immediate after removing neoplasm.
CASE REPORT
A 63 year old patient were hospitalized with pathohistologically confirmed-squamocellular carcinoma. The tumor were in the region of the ventral part of the mouth. Magnetic resonance imaging (MRI) and ultrasound investigation of the head and neck showed detectable nodes in the right side of the neck and suspicious nodes in the left side of the neck. Through the transmandibular approach it was performed a wide local excision of the tumor. IHNMCF was harvested from the right side. It was performed meticulous microvascular procedure venous end-to-end anastomosis of the right superior thyroid vein to the left superior thyroid vein. Patient is during procedure subjected to the supraomohyoid neck dissection on the left side and radical neck dissection on the right side.
DISCUSSION AND CONCLUSION
Disadvantage of this modified infrahyoid flap is the extremely limited arc of rotation. This seriously limits its applications to specific situations, where defects are located very close to the flap. Othervise, advantage of this modified flap is that radical neck dissection is not contraindication anymore. In this case flap was successful, without flap necrosis or complications in the donor side. Speech and swallow were without significant decrease. After radiation therapy flap remained sufficiently soft, trophic and mobile.