Scapular osteocutaneous free flap for total lower lip and mandible reconstruction
Scapular osteocutaneous free flap for total lower lip and mandible reconstruction
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DOI：
10.1002/micr.30040
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发表时间：
2016-02
期刊：
影响因子：
2.1
通讯作者：
Lia Jacobson;Raj D. Dedhia;N. Kokot;A. Chalian
中科院分区：
文献类型：
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作者：
Lia Jacobson;Raj D. Dedhia;N. Kokot;A. Chalian
肿瘤切除后的全下唇和下颌骨缺损重建具有挑战性。使用双游离皮瓣会增加供区发病率和皮瓣失败的风险。我们提出了一个单一的肩胛游离皮瓣的方法，独特的使用截骨唇再造的一小部分患者。方法：2007年至2012年对3例需要大切除的口腔鳞状细胞癌患者进行了病例系列研究。患者年龄范围为34 - 64岁。应用肩胛骨游离皮瓣修复下颌骨、口底、下唇及颏部缺损，缺损面积7 × 4cm ~ 11 × 7 cm。取骨向内侧延伸超过肩胛骨外侧缘。截骨术的方向是支持软组织瓣，以重建唇高度和恢复口腔功能。结果：皮肤桨的尺寸范围为10 - 11 cm × 18 - 25 cm。未报告骨瓣尺寸，但截骨的垂直高度范围为3 - 4 cm。所有皮瓣均成活。一名患者患有肩关节功能障碍和流涎，需要进行第二次手术。第二名患者在放疗后出现硬件暴露。随访时间范围为10至36个月。术后9个月，所有患者均获得良好的口腔能力和美观。结论：这种单皮瓣入路可能为全下唇和下颌骨的双游离皮瓣重建提供一种替代方法。© 2016 Wiley Periodicals，Inc.显微外科36：480-484，2016年。
Total lower lip and mandible defects following tumor resection present challenging reconstructions. The use of dual free flaps leads to increased donor‐site morbidity and risk of flap failure. We present a single scapular free flap approach with unique use of osteotomies for lip reconstruction in a small series of patients. Methods: A case series was conducted from 2007 to 2012 on three patients with squamous cell carcinoma of the oral cavity requiring large resection. Patients ranged in age from 34 to 64 years. A scapular free flap was used for reconstruction of mandible, floor of mouth, total lower lip and chin defects ranging in size from 7 × 4 cm to 11 × 7 cm. Harvested bone was extended medially beyond the lateral border of scapula. Osteotomies were oriented to support the soft tissue flap to rebuild lip height and restore oral competence. Results: Skin paddles ranged in size from 10‐11 cm × 18‐25 cm. Bone flap size was not reported but vertical height of osteotomies ranged from 3‐4 cm. All flaps survived microvascular transfer. One patient suffered from shoulder dysfunction and sialorrhea necessitating a second procedure. A second patient developed exposed hardware after radiation. Follow‐up ranged from 10 to 36 months. All patients achieved good oral competence and cosmesis by 9 months post‐operative. Conclusions: This single‐flap approach may provide an alternative to dual free flap reconstruction of total lower lip and mandible. © 2016 Wiley Periodicals, Inc. Microsurgery 36:480–484, 2016.