Weinand Christian, Dittes Carsten
Department of Plastic and Reconstructive Surgery, Hand Surgery, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Germany.
Department of Oral- Maxillo-Facial Surgery, Plastic Operations, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Germany.
World J Plast Surg. 2019 Jan;8(1):103-107. doi: 10.29252/wjps.8.1.103.
Head and neck squamous cell carcinoma (HNSCC) is the most frequent carcinoma of the head and neck region. For coverage of an entire resected mandible with floor of the mouth, 3/4 of the tongue and soft tissue of cheeks and neck bony reconstruction of the mandible and soft tissue reconstruction of tongue, cheeks and a neck large flap are needed. A patient with a superinfected T4 HNSCC was presented to our outpatient clinic. Complete resection of the mandible, bilateral neck dissection and 3/4 resection of the tongue were performed. A complex reconstruction using two free flaps was not feasable, so a large, folded, suprafascial Antero Lateral Thigh Perforator (ALTP) flap for immediate soft tissue reconstruction was used. Because of the anatomy, no reconstruction plate was inserted. On postop day 11, an understandable speaking was possible using a speach canula. Swallowing was possible without regurgitation. Eight months postoperatively, the patients mimic and closure of the mouth were satisfactory. The flap was viable throughout the entire time. It was shown that the suprafascial ALTP flap was a versatile part in the armamentarium for complex mandible soft tissue reconstruction.
头颈部鳞状细胞癌（HNSCC）是头颈部区域最常见的癌症。对于整个下颌骨切除并累及口底、3/4舌体以及颊部和颈部软组织的情况，需要进行下颌骨的骨重建以及舌、颊部和颈部的软组织重建，即采用大型皮瓣。一名患有T4期HNSCC且伴有感染的患者前来我们门诊就诊。对其实施了下颌骨全切术、双侧颈清扫术以及舌体3/4切除术。由于无法采用两个游离皮瓣进行复杂重建，因此使用了一个大型、折叠的股前外侧穿支（ALTP）皮瓣进行即刻软组织重建。鉴于解剖结构原因，未植入重建钢板。术后第11天，患者使用语音插管能够进行可理解的说话。吞咽时无反流现象。术后8个月，患者的面部表情和口腔闭合情况令人满意。整个期间皮瓣存活良好。结果表明，股前外侧穿支皮瓣在复杂下颌骨软组织重建的手段中是一种多功能的皮瓣。
