Teknos Theodoros N, Nussenbaum Brian, Bradford Carol R, Prince Mark E, El-Kashlan Hussam, Chepeha Douglas B
Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI 48109-0312, USA.
Otolaryngol Head Neck Surg. 2003 Sep;129(3):183-91. doi: 10.1016/S0194-5998(03)00718-6.
The study goal was to show that the lateral arm flap is a viable reconstructive option for complex parotidectomy defects.Study design and setting We studied a case series at a tertiary care medical center from March 1997 to March 2002. The lateral arm flap was used to reconstruct parotidectomy defects that included a composite resection of adjacent tissue in 30 patients. There were 19 men and 11 women (mean age, 62 years; mean follow-up, 19 months). The mean flap area was 114 cm(2), and the mean flap volume was 172 cm(3). The posterior cutaneous nerve of the forearm (PCNF) was used as a facial nerve cable graft in 14 patients. Facial disability outcomes were measured using the Facial Clinimetric Evaluation scale.
The major and minor complication rates with use of this reconstructive approach were low: 16.7% (5 of 30) and 26.7% (8 of 30), respectively. Donor site morbidity was minimal, with no patient having a major donor site complication and 23.3% (7 of 30) having minor complications. Functional recovery of the facial nerve occurred in 6 of 8 evaluable patients who underwent facial nerve grafting using the PCNF. Controlling for degree of facial nerve paralysis, Facial Clinimetric Evaluation scale scores of our patients were not statistically different than those of a historic population with a facial paralysis and no surgical defect.
The lateral arm free flap effectively restores facial appearance when used for reconstruction of complex parotidectomy defects. The PCNF, a nerve harvested with the lateral arm flap, can be used as a facial nerve cable graft with a high rate of success.
The lateral arm flap is successful as a single donor site for reconstructing facial contour and the facial nerve after major ablative defects in the parotid region.
本研究旨在表明上臂外侧皮瓣是修复腮腺切除术复杂缺损的一种可行的重建选择。
我们对1997年3月至2002年3月在一家三级医疗中心的一系列病例进行了研究。使用上臂外侧皮瓣修复腮腺切除术缺损，其中包括30例患者的相邻组织复合切除。患者中有19名男性和11名女性（平均年龄62岁；平均随访时间19个月）。皮瓣平均面积为114平方厘米，平均体积为172立方厘米。14例患者使用前臂后皮神经（PCNF）作为面神经电缆移植。使用面部临床测量评估量表对面部功能障碍结果进行测量。
采用这种重建方法的主要和次要并发症发生率较低，分别为16.7%（30例中的5例）和26.7%（30例中的8例）。供区并发症极少，没有患者出现严重的供区并发症，23.3%（30例中的7例）出现轻微并发症。在8例接受使用PCNF进行面神经移植的可评估患者中，有6例面神经功能恢复。在控制面神经麻痹程度后，我们患者的面部临床测量评估量表得分与无手术缺损的面瘫历史人群相比，无统计学差异。
上臂外侧游离皮瓣用于修复腮腺切除术复杂缺损时，能有效恢复面部外观。与上臂外侧皮瓣一起获取的PCNF神经可作为面神经电缆移植，成功率较高
