Department of Oral & Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
J Craniomaxillofac Surg. 2012 Dec;40(8):e293-300. doi: 10.1016/j.jcms.2012.01.006. Epub 2012 Feb 28.
The purpose of this study was to consider the indications and evaluate the clinical advantages and disadvantages including, results and complications, of immediate reconstruction using a latissimus dorsi (LD) free flap and reconstruction plate (R-plate) in advanced oro-mandibular tumour resection.
Our cohort included 116 patients who underwent LD free flap and R-plate reconstruction. Flap survival, postoperative function, donor/recipient site complication and aesthetics were evaluated.
Our series demonstrated a 99.1% flap survival rate. One case required a contralateral LD free flap reconstruction after the initial flap failed due to pedicle kinking. Twelve patients needed the plate to be removed and replaced (n=4, plate fracture; n=2, plate exposure) or definite reconstruction with free fibular flap and implant installation. Donor site complications included seroma accumulation, scarring, and discomfort of the shoulder girdle. The size of the skin paddle ranged from 6 × 10 cm to 12 × 18 cm (12 were double paddled).The facial contour was acceptable without sagging of the flap. The flap was tolerant to irradiation and was resistant to the exposure of the plate at the symphyseal arch.
Our series of primary reconstruction with LD free flaps and R-plates showed the retention of mandibular function and the reconstruction of considerably large soft tissue can be achieved successfully. This reconstruction scheme can be indicated for large-volume defects in the oro-mandibular area when the area cannot be covered by a single osteocutaneous free flap, has undergone extensive oncologic resection for advanced or high recurrence rate malignancy and when immediate postoperative chemotherapy and/or irradiation is necessary.
本研究旨在探讨晚期口颌面部肿瘤切除术后应用背阔肌游离皮瓣（LD）和重建钢板（R 板）即刻重建的适应证，并评价其临床优缺点，包括结果和并发症。
我们的队列包括 116 例接受 LD 游离皮瓣和 R 板重建的患者。评估了皮瓣存活率、术后功能、供区/受区并发症和美观度。
我们的系列研究显示皮瓣存活率为 99.1%。1 例因蒂扭转导致初始皮瓣失败后需要对侧 LD 游离皮瓣重建。12 例患者需要取出和更换钢板（n=4，钢板骨折；n=2，钢板外露）或用游离腓骨瓣和植入物安装进行确定性重建。供区并发症包括血清肿积聚、瘢痕和肩胛带不适。皮瓣的皮肤瓣大小从 6×10cm 到 12×18cm（12 例为双皮瓣）。面部轮廓可接受，无皮瓣下垂。皮瓣能耐受照射，且能抵抗在联合弓处的钢板外露。
我们的 LD 游离皮瓣和 R 板一期重建系列研究表明，保留了下颌功能，并成功重建了相当大的软组织量。当口颌区域的缺损无法被单个骨皮瓣覆盖、已进行广泛的肿瘤切除术治疗晚期或高复发率的恶性肿瘤，且需要即刻术后化疗和/或照射时，可以采用这种重建方案。
