Jung Bok Ki, Song Seung Yong, Kim Se-Heon, Kim Young Seok, Lee Won Jai, Hong Jong Won, Roh Tai Suk, Lew Dae Hyun
Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Otorhinolaryngology, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Arch Plast Surg. 2015 Jul;42(4):453-60. doi: 10.5999/aps.2015.42.4.453. Epub 2015 Jul 14.
Reconstruction of oropharyngeal defects after resection of oropharyngeal cancer is a significant challenge. The purpose of this study is to introduce reconstruction using a combination of a buccinator myomucosal flap and a buccal fat pad flap after cancer excision and to discuss the associated anatomy, surgical procedure, and clinical applications.
In our study, a combination of a buccinator myomucosal flap with a buccal fat pad flap was utilized for reconstruction after resection of oropharyngeal cancer, performed between 2013 and 2015. After oropharyngectomy, the defect with exposed vital structures was noted. A buccinator myomucosal flap was designed and elevated after an assessment of the flap pedicle. Without requiring an additional procedure, a buccal fat pad flap was easily harvested in the same field and gently pulled to obtain sufficient volume. The flaps were rotated and covered the defect. In addition, using cadaver dissections, we investigated the feasibility of transposing the flaps into the lateral oropharyngeal defect.
The reconstruction was performed in patients with squamous cell carcinoma. The largest tumor size was 5 cm×2 cm (length×width). All donor sites were closed primarily. The flaps were completely epithelialized after four weeks, and the patients were followed up for at least six months. There were no flap failures or postoperative wound complications. All patients were without dietary restrictions, and no patient had problems related to mouth opening, swallowing, or speech.
A buccinator myomucosal flap with a buccal fat pad flap is a reliable and valuable option in the reconstruction of oropharyngeal defects after cancer resection for maintaining functionality.
口咽癌切除术后口咽缺损的重建是一项重大挑战。本研究的目的是介绍在癌症切除后联合使用颊肌黏膜瓣和颊脂垫瓣进行重建，并探讨相关的解剖结构、手术步骤及临床应用。
在我们的研究中，2013年至2015年间对接受口咽癌切除术后的患者采用颊肌黏膜瓣与颊脂垫瓣联合进行重建。口咽切除术后，记录暴露重要结构的缺损情况。评估皮瓣蒂部后设计并掀起颊肌黏膜瓣。无需额外操作，即可在同一术野轻松获取颊脂垫瓣，并轻柔牵拉以获得足够体积。将皮瓣旋转并覆盖缺损。此外，通过尸体解剖，我们研究了将皮瓣转移至口咽侧方缺损的可行性。
对鳞状细胞癌患者进行了重建。最大肿瘤尺寸为5 cm×2 cm（长×宽）。所有供区均一期关闭。四周后皮瓣完全上皮化，患者至少随访六个月。未出现皮瓣坏死或术后伤口并发症。所有患者无饮食限制，无患者存在张口、吞咽或言语相关问题。
颊肌黏膜瓣联合颊脂垫瓣是癌症切除术后口咽缺损重建中维持功能的一种可靠且有价值的选择。
