Makiguchi Takaya, Yokoo Satoshi, Takayama Yu, Miyazaki Hidetaka, Terashi Hiroto
*Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Kobe †Department of Plastic Surgery, Kobe University Graduate School of Medicine, Gunma, Japan.
J Craniofac Surg. 2015 Oct;26(7):e622-4. doi: 10.1097/SCS.0000000000002001.
The double free flap procedure is a preferred treatment for extensive composite defects of the oromandibular area. In this procedure, the choice and use of the flaps are both important. Flaps with adequate soft tissue are required to fill the extensive dead space for huge oromandibular defects. Such flaps, however, tend to sink and droop with time because of gravity, resulting in poor functional and aesthetic results. Here, the authors describe a procedure that avoids flap sinking and drooping, using a vascularized fibular osteocutaneous flap, which is well established for mandibular bone defects, and a rectus abdominalis musculocutaneous flap, which has a lot of soft tissue and a firm anterior rectus sheath. This method was used in 2 patients with extensive composite defects of the oromandibular area. In a patient with resection of the mobile tongue and oral floor, the anterior rectus sheath was fixed to the fibula and mandible to give a mylohyoid muscle-like structure, to prevent sinking of the reconstructed oral floor and tongue. Good swallowing function was maintained. In a patient with defects transversally from the submandibular region to the cheek, the sheath was fixed to the zygomatic arch to prevent cheek drooping. An acceptable aesthetic result was obtained.
双游离皮瓣手术是治疗口颌面部大面积复合缺损的首选方法。在该手术中，皮瓣的选择和使用都很重要。需要有足够软组织的皮瓣来填充口颌部巨大缺损所形成的大面积死腔。然而，由于重力作用，这类皮瓣往往会随着时间推移而下沉和下垂，导致功能和美观效果不佳。在此，作者描述了一种避免皮瓣下沉和下垂的手术方法，即使用已广泛用于下颌骨缺损的带血管蒂腓骨骨皮瓣和具有大量软组织及坚韧腹直肌前鞘的腹直肌肌皮瓣。该方法应用于2例口颌面部大面积复合缺损患者。在1例活动期舌及口底切除患者中，将腹直肌前鞘固定于腓骨和下颌骨，形成类似下颌舌骨肌的结构，以防止重建的口底和舌下沉。吞咽功能得以良好维持。在1例从下颌下区至颊部横向缺损患者中，将该鞘固定于颧弓以防止颊部下垂。获得了可接受的美观效果。
