Cohen Leslie E, Morrison Kerry A, Taylor Erin, Jin Julia, Spector Jason A, Caruana Salvatore, Rohde Christine H
Ann Plast Surg. 2018 Apr;80(4 Suppl 4):S150-S155. doi: 10.1097/SAP.0000000000001373.
Traditional free flap reconstruction of complex intraoral defects often uses large lip-splitting incisions. To reduce morbidity and preserve aesthetics, we have adopted a more technically demanding visor technique obviating an incision through the lower lip through which the resection and reconstruction are performed.
A retrospective review was performed of patients who underwent free flap reconstruction of intraoral defects over 7 years by a single plastic surgeon (C.H.R.) at a single institution. Patients were included if they underwent a resection from the mandible, tongue, or floor of mouth followed by free tissue transfer as a reconstructive approach. Patients were excluded if they underwent reconstruction of an area that does not traditionally require a lip incision, such as a maxillectomy or laryngeal defect. An ablative approach was taken via a lip-split technique or visor technique. Wound complications, margins of resection, and functional outcomes were assessed. Two standardized questionnaires (Derriford Appearance Scale Short Form and Quality of Life Questionnaire for Head and Neck Cancer) were used to assess psychological distress and dysfunction from disfigurement, speech quality, and oral function. Preoperative and postoperative patient photos were evaluated.
Of 27 patients (mean ± SD age, 58.33 ± 13.02 years), 52% (14) had visor reconstructions whereas 48% (13) had lip-splitting reconstructions. About 78.6% of visor patients had widely-free margins compared with 46.2% of the lip-split patients. No differences in surgical-site complications between the lip-split and visor group (38.5% vs 28.6%) or in operative times were observed. Ninety-three percent of visor patients versus 54% of lip-split patients tolerated oral feeds at 1 year. Lip-split patients rated their quality of eating and speech worse than the visor patients (Quality of Life Questionnaire for Head and Neck Cancer mean score, 2.2 vs 1.56). Patients and clinical staff deemed visor reconstructions resulted in less visible sequelae.
A visor technique with no lip-split incision for intraoral free flap reconstruction is an oncologically safe technique to consider that may improve cosmetic and functional outcomes for head and neck reconstruction patients.
传统的复杂口腔内缺损游离皮瓣重建术通常采用大的唇裂切口。为了降低发病率并保持美观，我们采用了一种技术要求更高的面罩技术，避免在下唇做切口来进行切除和重建。
对一位整形外科医生（C.H.R.）在一家机构7年内进行口腔内缺损游离皮瓣重建的患者进行回顾性研究。如果患者接受了下颌骨、舌或口底切除，随后采用游离组织移植作为重建方法，则纳入研究。如果患者接受的是传统上不需要唇切口的区域的重建，如上颌骨切除术或喉部缺损，则排除在外。通过唇裂技术或面罩技术进行切除。评估伤口并发症、切除边缘和功能结果。使用两份标准化问卷（德里福德外貌量表简表和头颈癌生活质量问卷）评估因毁容、语音质量和口腔功能导致的心理困扰和功能障碍。对患者术前和术后照片进行评估。
27例患者（平均年龄±标准差，58.33±13.02岁）中，52%（14例）采用面罩重建，48%（13例）采用唇裂重建。约78.6%的面罩重建患者切缘广泛阴性，而唇裂重建患者为46.2%。唇裂组和面罩组手术部位并发症（38.5%对28.6%）或手术时间无差异。93%的面罩重建患者与54%的唇裂重建患者在1年后能够耐受经口进食。唇裂重建患者对饮食和语音质量的评分低于面罩重建患者（头颈癌生活质量问卷平均得分，分别为2.2和1.56）。患者和临床工作人员认为面罩重建导致的后遗症不太明显。
用于口腔内游离皮瓣重建的无唇裂切口面罩技术是一种在肿瘤学上安全的技术，可考虑用于改善头颈重建患者的美容和功能效果。
