Granick M S, Ramasastry S S, Newton E D, Solomon M P, Hanna D C, Kaltman S
Department of Surgery, Hahnemann University, Philadelphia, Pennsylvania.
Head Neck. 1990 Sep-Oct;12(5):377-85. doi: 10.1002/hed.2880120502.
The defect resulting from partial or complete maxillectomy can often be reconstructed with a skin graft and a prosthesis. In situations where this simple maneuver is unsatisfactory, a more complex reconstructive modality, providing the restoration of composite tissue, is required. The scapular microvascular-free flap was used in this series of 11 patients, as a cutaneous flap in 3 and as an osteocutaneous flap in 8, to meet the specific reconstructive needs of each patient. Excellent to satisfactory restoration of facial contour and palatal function was achieved in 10 patients. There was 1 flap failure. There were no donor site complications. Selected case histories are presented to demonstrate a spectrum of reconstructive problems. There are clear limitations to its applicability, such as the odd scapular bone contour, the thickness of the cutaneous paddle, the position change required for flap harvesting, and the risk of flap failure. The scapular flap has proven to be useful in restoring bony and soft tissue contour of the face, rigid support for the velum, oronasal separation, support for the orbit, and obliteration of the maxillary sinus. We found the scapular-free flap to be a useful tool for reconstructing complex and variable maxillectomy defects.
部分或全上颌骨切除术后造成的缺损通常可用皮肤移植和假体进行修复。在这种简单方法效果不佳的情况下，则需要采用更复杂的重建方式，以恢复复合组织。本系列11例患者采用了肩胛游离微血管皮瓣，其中3例用作皮瓣，8例用作骨皮瓣，以满足每位患者的特定重建需求。10例患者面部轮廓和腭功能恢复良好至满意。有1例皮瓣失败。供区无并发症。现展示部分病例以说明一系列重建问题。其适用性存在明显局限性，如肩胛骨外形奇特、皮瓣厚度、切取皮瓣所需的体位改变以及皮瓣失败风险等。肩胛皮瓣已被证明在恢复面部骨和软组织轮廓、为软腭提供坚固支撑、口鼻分隔、眼眶支撑以及上颌窦填塞方面很有用。我们发现肩胛游离皮瓣是修复复杂多变的上颌骨切除术后缺损的有用工具。
