A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients
A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients
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DOI：
10.1016/j.bjps.2007.09.056
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发表时间：
2009-06-01
影响因子：
2.7
通讯作者：
Kimata, Yoshihiro
中科院分区：
文献类型：
--
作者：
Sakuraba, Minoru;Asano, Takayuki;Kimata, Yoshihiro
目的：在舌全切除或次全切除后的舌重建中，经常使用腹直肌皮瓣来获得足够的皮瓣体积。然而，瘦弱的患者往往脂肪组织太少，无法保证足够的皮瓣体积。因此，我们开发了一种新的皮瓣设计，以弥补薄患者皮瓣体积不足。方法：对20例平均年龄58.3岁的消瘦男性行全或次全舌切除术。这些患者的平均体重指数为18.22 kg/m(2)，大多数被认为是瘦弱的。采用带两个皮肤岛的腹直肌皮瓣重建缺损。第一个皮肤岛用于重建粘膜缺损，第二个去上皮化用于增加皮瓣体积。结果：20例患者中19例皮瓣移植成功。大多数病人都能忍受软性饮食而不会严重误吸，并能进行交谈。然而，由于严重的误吸，4例患者需要全喉切除术或永久性造口。在本系列中，80%的瘦弱患者喉部得以保留，术后口腔功能良好。结论：舌形突出，体积足够，是获得满意口腔功能的关键。应用去上皮化的腹直肌皮游离皮瓣可以维持足够的皮瓣体积。我们相信我们的新皮瓣设计是有效的舌重建瘦病人。(C) 2008年英国整形、重建和美容外科医师协会。Elsevier Ltd.出版。版权所有。
Objective: For tongue reconstruction after total or subtotal glossectomy, a rectus abdominis musculocutaneous flap is often used to obtain sufficient flap volume. However, thin patients often have too little fat tissue to ensure adequate flap volume. For this reason we developed a new flap design to compensate for insufficient flap volume in thin patients.Methods: In this series, total or subtotal glossectomy was performed in 20 thin men with a mean age of 58.3 years. The patients had a mean body mass index of 18.22 kg/m(2) and most were considered emaciated. The defects were reconstructed using a rectus abdominis musculocutaneous flap with two skin islands. The first skin island was used to reconstruct the mucosal defect, and the second was de-epithelialised and used to increase flap volume.Results: Flaps were transferred successfully in 19 out of 20 patients. Most patients could tolerate more than a soft diet without severe aspiration and could engage in conversation. However, four patients required total laryngectomy or a permanent stoma owing to severe aspiration. In this series, the larynx could be preserved in 80% of thin patients, and satisfactory postoperative oral function was obtained.Conclusion: The most important point for obtaining satisfactory oral function is to reconstruct a tongue with a protuberant shape and sufficient volume. We could maintain sufficient flap volume with the de-epithelialised skin island of a rectus abdominis musculocutaneous free flap. We believe our new flap design is effective for tongue reconstruction in thin patients. (C) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.