Modest Mara C, Moore Eric J, Abel Kathryn M Van, Janus Jeffrey R, Sims John R, Price Daniel L, Olsen Kerry D
Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Laryngoscope. 2017 Jan;127(1):E8-E14. doi: 10.1002/lary.26351. Epub 2016 Oct 12.
OBJECTIVES/HYPOTHESIS: Discuss current techniques utilizing the scapular tip and subscapular system for free tissue reconstruction of maxillary defects and highlight the impact of medical modeling on these techniques with a case series.
Case review series at an academic hospital of patients undergoing maxillectomy + thoracodorsal scapula composite free flap (TSCF) reconstruction. Three-dimensional (3D) models were used in the last five cases.
3D modeling, surgical, functional, and aesthetic outcomes were reviewed.
Nine patients underwent TSCF reconstruction for maxillectomy defects (median age = 43 years; range, 19-66 years). Five patients (55%) had a total maxillectomy (TM) ± orbital exenteration, whereas four patients (44%) underwent subtotal palatal maxillectomy. For TM, the contralateral scapula tip was positioned with its natural concavity recreating facial contour. The laterally based vascular pedicle was ideally positioned for facial vessel anastomosis. For subtotal-palatal defect, an ipsilateral flap was harvested, but inset with the convex surface facing superiorly. Once 3D models were available from our anatomic modeling lab, they were used for intraoperative planning of the last five patients. Use of the model intraoperatively improved efficiency and allowed for better contouring/plating of the TSCF. At last follow-up, all patients had good functional outcomes. Aesthetic outcomes were more successful in patients where 3D-modeling was used (100% vs. 50%). There were no flap failures. Median follow-up >1 month was 5.2 months (range, 1-32.7 months).
Reconstruction of maxillectomy defects is complex. Successful aesthetic and functional outcomes are critical to patient satisfaction. The TSCF is a versatile flap. Based on defect type, choosing laterality is crucial for proper vessel orientation and outcomes. The use of internally produced 3D models has helped refine intraoperative contouring and flap inset, leading to more successful outcomes.
目的/假设：探讨利用肩胛尖和肩胛下系统进行上颌骨缺损游离组织重建的当前技术，并通过一个病例系列突出医学建模对这些技术的影响。
在一家学术医院对接受上颌骨切除术 + 胸背肩胛复合游离皮瓣（TSCF）重建的患者进行病例回顾系列研究。最后5例患者使用了三维（3D）模型。
回顾3D建模、手术、功能和美学结果。
9例患者接受了TSCF重建以修复上颌骨切除术缺损（中位年龄 = 43岁；范围19 - 66岁）。5例患者（55%）进行了全上颌骨切除术（TM）±眶内容摘除术，而4例患者（44%）接受了次全腭部上颌骨切除术。对于TM，对侧肩胛尖以其自然凹陷来重建面部轮廓的方式定位。基于外侧的血管蒂处于理想位置以便与面部血管吻合。对于次全腭部缺损，采用同侧皮瓣，但植入时凸面朝上。一旦我们的解剖建模实验室有了3D模型，就将其用于最后5例患者的术中规划。术中使用模型提高了效率，并使TSCF的塑形/接骨板固定更好。在最后一次随访时，所有患者功能结果良好。使用3D建模的患者美学结果更成功（100%对50%）。没有皮瓣失败情况。中位随访时间>1个月为5.2个月（范围1 - 32.7个月）。
上颌骨切除术缺损的重建很复杂。成功的美学和功能结果对患者满意度至关重要。TSCF是一种多功能皮瓣。根据缺损类型，选择皮瓣的侧别对于正确的血管定位和结果至关重要。内部制作的3D模型的使用有助于优化术中塑形和皮瓣植入，从而带来更成功的结果。
4。《喉镜》，127:E8 - E14，2017年。
