Lin Ying-Sheng, Liu Wen-Chung, Wang Kuan-Ying, Lin Yaoh-Shiang, Yang Kuo-Chung
Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Division of Plastic and Reconstructive Surgery, National Taiwan University Hospital Yulin Branch, Yulin County, Taiwan.
Microsurgery. 2019 Feb;39(2):108-114. doi: 10.1002/micr.30322. Epub 2018 Mar 30.
To reconstruct extensive head and neck defects usually necessitates double free flaps, which require a time-and-manpower-consuming surgical procedure. We present using a single fibula or peroneal flap with the novel design of obliquely-arranged double skin paddles to reconstruct an extensive head and neck defect.
From 1998 to 2016, eight patients with the age of 52.25 (35-71) years old had extensive head and neck defects after oral cancer ablation. All of the defects were through and through with the size of 16.25 (12-24) cm × 8.8 (4.5-11) cm. Six of the defects were due to buccal cancer. One was due to tongue cancer, and another one was due to gingiva cancer. All the defects were reconstructed with obliquely-arranged double-paddle free fibula or peroneal flaps. The long axis of the skin paddles was arranged at certain angle (30-45 degrees) to the long axis of lower leg, and the two separate skin paddles were used as the form of island flaps by isolating the cutaneous perforators to create a true chimeric flap.
The skin paddle sizes were 14 cm × 3 cm-24 cm × 11 cm and 9.5 cm × 4.5 cm-13 cm × 8 cm. The average length of harvested fibula was 19 (10-30) cm. All of the eight flaps survived without obvious donor site morbidity. One patient had partial skin necrosis over recipient site, requiring surgical debridements and closure. One patient had superficial necrosis over the edge of outer skin paddle, which healed spontaneously. After the follow-up periods of 1 month to 3 year and 8 months, two patients died of sepsis. Six of them could resume soft diet and had no saliva drooling. The remaining two remained nasogastric diet and had saliva drooling.
With the design of obliquely-arranged double paddles, we may maximize the harvested skin area of lateral lower leg to reconstruct an extensive head and neck defect with a single free flap.
重建广泛的头颈部缺损通常需要双游离皮瓣，这需要耗时且耗费人力的手术操作。我们介绍使用带有斜向排列双皮瓣的新颖设计的单一腓骨或腓骨皮瓣来重建广泛的头颈部缺损。
1998年至2016年，8例年龄为52.25（35 - 71）岁的患者在口腔癌切除术后出现广泛的头颈部缺损。所有缺损均为贯通性，大小为16.25（12 - 24）cm×8.8（4.5 - 11）cm。其中6例缺损由颊癌导致。1例由舌癌导致，另1例由牙龈癌导致。所有缺损均采用斜向排列的双叶游离腓骨或腓骨皮瓣进行重建。皮瓣的长轴与小腿长轴呈一定角度（30 - 45度）排列，通过分离皮穿支将两个独立的皮瓣作为岛状皮瓣形式使用，以创建真正的嵌合皮瓣。
皮瓣大小为14 cm×3 cm - 24 cm×11 cm和9.5 cm×4.5 cm - 13 cm×8 cm。切取的腓骨平均长度为19（10 - 30）cm。所有8个皮瓣均存活，供区无明显并发症。1例患者受区出现部分皮肤坏死，需要手术清创和缝合。1例患者外侧皮瓣边缘出现浅表坏死，自行愈合。经过1个月至3年8个月的随访，2例患者死于败血症。其中6例患者可恢复软食，无流涎。其余2例仍需鼻饲饮食，并有流涎。
通过斜向排列双叶的设计，我们可以最大化小腿外侧的切取皮肤面积，用单一游离皮瓣重建广泛的头颈部缺损。
