Acartürk Tahsin Oğuz, Maldonado Andrés A, Ereso Alex
Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Plastic Surgery and Burns, University Hospital of Getafe, Madrid, Spain.
Microsurgery. 2015 Jul;35(5):399-402. doi: 10.1002/micr.22366. Epub 2014 Dec 20.
Free fasciocutaneous flaps like the radial forearm free flap (RFFF) and the anterolateral thigh (ALT) are the most commonly used flaps in intraoral reconstruction. However, certain conditions preclude the use of either of these flaps. The aim of this report was to show applicability of "thinned" peroneal artery perforator (PAP) flaps in intraoral reconstruction. We report two cases of squamous cell carcinoma involving the tongue and floor of the mouth, where one patient had advanced scleroderma with tight forearm skin and the other with a history of Reynaud's disease precluding the use of RFFF. In addition, both patients were morbidly obese with thick adipose tissue in the thigh making ALT flap not a suitable option. Instead, a PAP flap was chosen. After the harvest, the subcutaneous tissue thickness was measured to be 2.2 and 1.8 cm, respectively. The thinning was performed by removing the deep fat lobules of the superficial fat layer down to a final thickness of 0.4 and 0.3 cm, respectively. A 2 × 2 cm area surrounding the perforators were kept untouched. Both patients had uneventful postoperative course with one patient having a small donor area dehiscence that healed with local wound care. The functional outcomes at 1 year were good. "Thinned" PAP flap is a unique and novel application that may be an alternative in intraoral reconstruction when primary choices are not available.
游离筋膜皮瓣，如桡侧前臂游离皮瓣（RFFF）和股前外侧皮瓣（ALT），是口腔内重建中最常用的皮瓣。然而，某些情况会妨碍使用这些皮瓣中的任何一种。本报告的目的是展示“减薄”的腓动脉穿支（PAP）皮瓣在口腔内重建中的适用性。我们报告了两例累及舌和口底的鳞状细胞癌病例，其中一例患者患有晚期硬皮病，前臂皮肤紧绷，另一例有雷诺病病史，无法使用RFFF。此外，两名患者均病态肥胖，大腿有厚厚的脂肪组织，使得ALT皮瓣不是合适的选择。取而代之的是选择了PAP皮瓣。切取皮瓣后，测量皮下组织厚度分别为2.2厘米和1.8厘米。减薄是通过去除浅脂肪层的深层脂肪小叶来进行的，最终厚度分别为0.4厘米和0.3厘米。围绕穿支的2×2厘米区域保持不动。两名患者术后过程均顺利，其中一名患者供区有小的裂开，经局部伤口护理后愈合。1年时的功能结果良好。“减薄”的PAP皮瓣是一种独特且新颖的应用，当主要选择不可用时，可能是口腔内重建的一种替代方法。
