Woo Soo Hyun, Bae Tae Hui, Kim Woo Seob, Kim Han Koo
Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
J Craniofac Surg. 2017 Oct;28(7):1828-1832. doi: 10.1097/SCS.0000000000003822.
Reconstruction of pharyngocutaneous fistula (PCF) or orocutaneous fistula is always a challenging task. It has many causes and is especially related to radiation therapy after resection of head and neck cancers. There are many reports of surgical procedures for fistula repair. For example, 2-stage methods, methods of combining multiple flaps, and methods of using chimeric flaps have been reported. However, there is no established simple method as a treatment of choice. The authors describe 5 patients of head and neck fistulas and recommend a useful 1-stage reconstruction method using a double skin paddle free flap.The authors modified the free flaps simply with a double skin paddle sharing 1 pedicle. The skin paddle of the flap was split into 2 parts, one skin island for inner mucosal coverage, and the other for outer skin resurfacing. The bridge between the 2 skin paddles was deepithelialized and then folded. To prevent leakage, a water-tight closure was ensured.The double skin paddle free flap method was used in 5 patients. Two patients had orocutaneous fistula, and the other 3 patients had PCF due to irradiation. Flap losses did not occur, but wound dehiscence was noted in the 3 PCF patients. Repeat wound revision procedures were performed in these patients, and the end result was good.Conventional methods are complex and require multiple flaps or repeat surgery. However, the double skin paddle free flap method allows for simple and effective 1-stage reconstruction using 1 flap, 1 pedicle, and 1 microanastomosis even for patients who received preoperative radiotherapy.
咽皮肤瘘（PCF）或口皮肤瘘的重建一直是一项具有挑战性的任务。其病因众多，尤其与头颈癌切除术后的放射治疗有关。关于瘘管修复的外科手术有许多报道。例如，有两阶段法、多种皮瓣联合法以及使用嵌合皮瓣法的报道。然而，目前尚无一种既定的简单方法可作为首选治疗方法。作者描述了5例头颈瘘患者，并推荐一种使用双皮瓣游离皮瓣的实用一期重建方法。作者对游离皮瓣进行了简单改良，采用共享1个蒂的双皮瓣。皮瓣的皮瓣被分成两部分，一个皮岛用于覆盖内侧黏膜，另一个用于外侧皮肤修复。两个皮瓣之间的桥接部分去上皮化后折叠。为防止渗漏，确保进行了水密缝合。双皮瓣游离皮瓣法应用于5例患者。2例患者为口皮肤瘘，另外3例患者因放疗导致咽皮肤瘘。未发生皮瓣丢失，但3例咽皮肤瘘患者出现了伤口裂开。对这些患者进行了重复伤口修复手术，最终结果良好。传统方法复杂，需要多个皮瓣或重复手术。然而，双皮瓣游离皮瓣法即使对于接受过术前放疗的患者，也能使用1个皮瓣、1个蒂和1次显微吻合进行简单有效的一期重建。
