Division of Plastic Surgery, Department of Surgery, Buddhist Tzu Chi Hualien General Hospital, Hualien, Taiwan.
J Reconstr Microsurg. 2010 Apr;26(3):145-51. doi: 10.1055/s-0029-1242134. Epub 2009 Nov 9.
Massive composite defects of the face are difficult to reconstruct. Such defects are usually created after ablation of advanced cancers of the head and neck region. The use of a free fibular osteocutaneous flap for the bone and mucosal lining of the oral cavity and anterolateral thigh flap for the outer cutaneous lining are well established. We present our experience of using these two flaps simultaneously in the reconstruction of such defects and to evaluate the outcome. There were a total of 10 patients in our study. Their average age was 48.8 years. All had squamous cell carcinoma of the oral cavity. Their pathological stages were mostly stage T4 with only one case being T3. Flap survival was 100%. The application of dual free flaps, though technically more demanding, allows good orientation of the flaps. Seven patients maintained a good functional outcome. They were able to eat a soft diet. Their speech was easily comprehensible. The combination of a free anterolateral thigh flap with vascularized fibular osteocutaneous flap can be performed safely with adequate functional outcome. This combination of flaps should be considered for this group of patients.
大面积的面部复合组织缺损较难重建。此类缺损通常发生在头颈部晚期癌症消融术后。游离腓骨骨皮瓣可用于口腔骨黏膜内层，股前外侧皮瓣可用于外部皮肤。我们在此介绍同时使用这两种皮瓣修复此类缺损的经验，并对其结果进行评估。本研究共纳入 10 例患者，平均年龄为 48.8 岁，均患有口腔鳞状细胞癌，其病理分期多为 T4 期，仅有 1 例为 T3 期。皮瓣存活率为 100%。应用双游离皮瓣虽然技术要求更高，但可以更好地定位皮瓣。7 例患者的功能恢复良好，他们可以进食软食，言语清晰可辨。游离股前外侧皮瓣与带血管腓骨骨皮瓣相结合，可安全实施，并获得良好的功能效果。对于这组患者，应考虑使用这种组合皮瓣。
