Department of Oromaxillofacial-Head and Neck Surgery, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
Department of Oral Maxillofacial Surgery School of Stomatology, China Medical University, No. 117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
World J Surg Oncol. 2018 Sep 28;16(1):194. doi: 10.1186/s12957-018-1492-5.
For reconstructive surgeons, massive midface defects, including large, full-thickness wounds on the upper lip, can be very challenging. Although there are many methods for reconstruction of upper lip defects, it is difficult to obtain satisfactory restoration of oral functions and good cosmetic results.
This case report presents a man with massive midface defects, including upper lip, left nose, and cheek defects. Over the previous 2 years, the patient had three reconstructions with sequential free flaps for the resection of recurrent tumors, the first of which was in March of 2016; this resulted in the patient having massive midface defects, including an upper lip defect, a defect on the left side of the nose, and one on the left cheek. The defects were reconstructed using a radial forearm free flap (RFFF), a facial artery musculomucosal (FAMM) flap, and a kite flap. In June 2016, he underwent a second reconstruction, this time of the left nose defect, using a left anterolateral thigh (ALT) flap. In March of 2017, the patient underwent a third reconstruction with the use of a free ALT on the left intraoral cheek and the defects on the neck. All flaps survived. No complications were encountered postoperatively. The patient regained good oral sphincter function with no reports of drooling. Although the patient underwent three surgeries, the reconstruction results were acceptable.
For massive midface defects, including large, full-thickness wounds on the upper lip, the combination of a FAMM flap, kite flap, and RFFF promotes the reconstruction of the complex midface structure and improves the resulting functionality.
对于重建外科医生来说，大面积的面中部缺损，包括上唇的大而全层伤口，极具挑战性。虽然有许多方法可以重建上唇缺损，但很难获得满意的口腔功能恢复和良好的美容效果。
本病例报告介绍了一名男子患有大面积面中部缺损，包括上唇、左鼻和颊部缺损。在过去的 2 年中，该患者因复发性肿瘤进行了三次游离皮瓣的连续重建，第一次是在 2016 年 3 月；这导致患者出现大面积面中部缺损，包括上唇缺损、左侧鼻侧缺损和左侧颊部缺损。使用桡侧游离前臂皮瓣（RFFF）、面动脉肌黏膜（FAMM）瓣和风筝皮瓣对缺损进行了重建。2016 年 6 月，患者接受了第二次重建，使用左侧股前外侧（ALT）皮瓣修复左侧鼻缺损。2017 年 3 月，患者接受了第三次重建，使用游离的左侧口腔颊部和颈部的 ALT 皮瓣修复缺损。所有皮瓣均存活。术后无并发症发生。患者恢复了良好的口腔括约肌功能，没有流口水的报告。尽管患者接受了三次手术，但重建结果是可以接受的。
对于大面积的面中部缺损，包括上唇的大而全层伤口，FAMM 瓣、风筝皮瓣和 RFFF 的联合应用促进了复杂面中部结构的重建，并提高了功能恢复效果。
