Sakakibara Akiko, Kusumoto Junya, Sakakibara Shunsuke, Hasegawa Takumi, Akashi Masaya, Minamikawa Tsutomu, Furudoi Shungo, Hashikawa Kazunobu, Komori Takahide
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Plast Reconstr Aesthet Surg. 2019 Jul;72(7):1135-1141. doi: 10.1016/j.bjps.2019.03.015. Epub 2019 Mar 23.
Forearm free flaps are used after hemiglossectomy. However, no investigation has been performed on whether oral functions are better preserved when sizes of the resection and reconstruction flap are exact matches, or whether the size of the resection should be changed. We aimed to retrospectively examine whether size differences between the resection and reconstruction flap affect speech and swallowing functions postoperatively, and to determine whether there are more favorable flap size ratios.
This is a retrospective cohort study of patients undergoing hemiglossectomy using a forearm free flap between 2006 and 2016 at Kobe University Hospital, Japan. The effect of size difference between the resection and reconstruction flap on maintained oral function was assessed. Speech and swallowing functions were assessed, and their correlation with the ratio of the flap size to that of the resected area was determined. With these data, distribution maps of the relationship between the functional level and reconstructed dimension ratio were prepared. The more suitable reconstructed dimension ratio was examined and evaluated. The Fisher exact test, Kruskal-Wallis test, and Scheffe test were used in statistical analyses.
Eighty-eight patients underwent hemiglossectomy using a forearm free flap during a 10-year period. Of these cases, 66 patients were included in this study, while 22 were excluded. The ratio of the area of the reconstruction flap to that of the resection site was 0.59-2.79 (median: 1.61). Sixty patients had flaps greater than the resection area, whereas 6 had smaller flaps. Significant differences were found in speech intelligibility and swallowing function when the reconstructed dimension ratio was categorized as follows: ≤1.3, 1.3-1.8, and ≥1.8.
Our findings suggest that postoperative deterioration of oral functions after hemiglossectomy could be reduced if reconstruction is performed using a forearm free flap with a surface area 1.3 to 1.8 times greater than that of the resection area.
前臂游离皮瓣用于半舌切除术后。然而，对于切除范围与重建皮瓣大小精确匹配时口腔功能是否能得到更好保留，或者切除范围是否应改变，尚未有相关研究。我们旨在回顾性研究切除范围与重建皮瓣之间的大小差异是否会影响术后的言语和吞咽功能，并确定是否存在更合适的皮瓣大小比例。
这是一项对2006年至2016年在日本神户大学医院接受半舌切除术并使用前臂游离皮瓣的患者进行的回顾性队列研究。评估了切除范围与重建皮瓣之间的大小差异对维持口腔功能的影响。评估了言语和吞咽功能，并确定了它们与皮瓣大小与切除区域大小之比的相关性。利用这些数据，绘制了功能水平与重建尺寸比例之间关系的分布图。对更合适的重建尺寸比例进行了研究和评估。统计分析采用Fisher精确检验、Kruskal-Wallis检验和Scheffe检验。
在10年期间，88例患者接受了使用前臂游离皮瓣的半舌切除术。其中，本研究纳入了66例患者，排除了22例。重建皮瓣面积与切除部位面积之比为0.59 - 2.79（中位数：1.61）。60例患者的皮瓣大于切除区域，而6例患者的皮瓣较小。当重建尺寸比例分为以下几类时：≤1.3、1.3 - 1.8和≥1.8，在言语清晰度和吞咽功能方面发现了显著差异。
我们的研究结果表明，如果使用表面积比切除区域大1.3至1.8倍的前臂游离皮瓣进行重建，半舌切除术后口腔功能的术后恶化可能会减少。
