Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India.
Department of Head & Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham Kochi, Kerala, India.
Oral Oncol. 2018 Aug;83:134-139. doi: 10.1016/j.oraloncology.2018.06.023. Epub 2018 Jun 23.
The purpose of this paper is to report the technique and outcomes of the use of gastro-omental free flap reconstruction in glossectomy defects.
This is a prospective case series of 9 patients of tongue squamous cell carcinoma, who underwent either subtotal or partial glossectomy and reconstruction with gastro-omental free flap. The flap anatomy, surgical technique and the outcomes including the swallowing and speech are presented.
Five patients underwent partial glossectomy and 4 had sub-total glossectomy. The median age was 43 years; and the median follow up was 11.4 months. Laparoscopic harvest was done in 8 patients. There was one flap loss. Seven patients underwent postoperative radiotherapy. Functional evaluation was done in 5 patients who were disease free. Four could tolerate soft diet orally, one patient was on liquid to pureed diet. Speech was intelligible in 4. None of the patients had any complications related to laparotomy or laparoscopy.
Gastro-omental flap provided a secretory mucosal surface and was beneficial in the saliva depleted patients post radiotherapy. The laparoscopic harvest of this flap has minimized donor site morbidity. One patient had a flap loss. Two patients reported superficial ulcerations on the surface, one of them had to undergo surgical debulking to correct it while the other healed with conservative measures. Speech and swallowing outcomes of the reconstructed tongue was good, especially in patients with partial glossectomy. The reconstructed gastric mucosal flaps tolerated the adjuvant radiation well.
本文旨在报告胃网膜游离皮瓣在舌切除术缺损重建中的技术和结果。
这是一项前瞻性的 9 例舌鳞癌患者病例系列研究，这些患者行半舌或全舌切除术，并采用胃网膜游离皮瓣重建。介绍了皮瓣解剖、手术技术以及包括吞咽和言语在内的结果。
5 例患者行半舌切除术，4 例患者行全舌切除术。中位年龄为 43 岁；中位随访时间为 11.4 个月。8 例患者行腹腔镜下采集。发生 1 例皮瓣坏死。7 例患者接受术后放疗。5 例无病患者进行了功能评估。4 例患者能经口耐受软食，1 例患者需经口进液体至泥状饮食。4 例患者的言语可理解。无患者出现与剖腹手术或腹腔镜相关的并发症。
胃网膜瓣提供了分泌性黏膜表面，对于放疗后唾液减少的患者有益。这种皮瓣的腹腔镜采集最大限度地减少了供区的发病率。1 例患者发生皮瓣坏死。2 例患者报告表面有浅表溃疡，其中 1 例需要手术切除以纠正，另 1 例则通过保守治疗愈合。重建舌的言语和吞咽功能良好，尤其是行半舌切除术的患者。接受辅助放疗的重建胃黏膜瓣耐受良好。
