Park Yun Yong, Ahn Hee Chang, Lee Jang Hyun, Chang Jung Woo
Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea.
Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
Arch Craniofac Surg. 2019 Feb;20(1):17-23. doi: 10.7181/acfs.2018.02061. Epub 2019 Feb 7.
The resection of head and neck cancer can result in postoperative defect. Many patients have difficulty swallowing and masticating, and some have difficulty speaking. Various types of flaps are used for palatal reconstruction, but flap selection remains controversial. Therefore, our study will suggest which flap to choose during palatal reconstruction.
Thirteen patients who underwent palatal reconstruction from 30 January, 1989 to 4 October, 2016 at our institution. Size was classified as small when the width was < 4 cm², medium when it was 4-6 cm², and large when it was ≥ 6 cm². Based on speech evaluation, the subjects were divided into a normal group and an easily understood group. After surgery, we assessed whether flap selection was appropriate through the evaluation of flap success, complications, and speech evaluation.
Defect size ranged from 1.5× 2.0 cm to 5.0× 6.0 cm. In four cases, the defect was in the anterior third of the palate, in eight cases it was in the middle, and there was one case of whole palatal defect. There were three small defects, two medium-sized defects, and eight large defects. Latissimus dorsi free flaps were used in six of the eight large defects in the study.
The key to successful reconstructive surgery is appropriate selection of the flap with reference to the characteristics of the defect. Depending on the size and location of the defect, the profiles of different flaps should be matched with the recipient from the outset.
头颈部癌切除术后可导致缺损。许多患者吞咽和咀嚼困难，部分患者存在言语障碍。腭部重建可采用多种皮瓣，但皮瓣的选择仍存在争议。因此，我们的研究将提示腭部重建时应选择何种皮瓣。
1989年1月30日至2016年10月4日在我院接受腭部重建的13例患者。当宽度<4 cm²时缺损大小分类为小，4 - 6 cm²时为中，≥6 cm²时为大。根据言语评估，将受试者分为正常组和易理解组。术后，我们通过评估皮瓣成功率、并发症及言语评估来判断皮瓣选择是否合适。
缺损大小范围为1.5×2.0 cm至5.0×6.0 cm。4例缺损位于腭部前三分之一，8例位于中部，1例为全腭部缺损。有3个小缺损、2个中等大小缺损和8个大缺损。本研究中8个大缺损中的6个采用了背阔肌游离皮瓣。
重建手术成功的关键在于根据缺损特点恰当选择皮瓣。根据缺损的大小和位置，不同皮瓣的形态应从一开始就与受区相匹配。
