Chakrabarti Swagnik, Panuganti Achyuth, Gupta Monika, Ghosh Abhishek, Bhukar Sandeep, Choubey Tanvi, Mishra Aseem, Sharma Sudhendhu Shekhar
Homi Bhabha Cancer Hospital, Varanasi, India.
Indian J Surg Oncol. 2020 Sep;11(3):462-468. doi: 10.1007/s13193-020-01123-5. Epub 2020 Jun 17.
Free flaps are the gold standard for reconstruction of extensive buccal cancer resections. However, salvage surgeries in previously operated and radiated necks, cost, increased operating time, and patient co-morbidities limit their routine use in high volume and resource-constrained settings. Pectoralis major myocutaneous (PMMC) flap is the mainstay of reconstruction of large buccal defects. However, reconstruction becomes a challenge during salvage of recurrences where PMMC has been utilized in previous reconstruction and in female patients where PMMC harvest results in major donor site morbidity. A retrospective analysis of clinical data of 13 consecutive patients (eight male and five female) with through and through buccal cancer resection defects reconstructed using pedicled latissimus dorsi (LD) flap from July 2018 to September 2019 was performed. The indications of using an LD flap were salvage surgeries for recurrences where PMMC was used in earlier reconstruction, medical co-morbidities, vessel depleted necks, and financial constraints precluding use of free flaps. The mean follow-up period was 9.84 months. The mean operating time post-resection was 2 h and 26 min. The mean hospital stay was 12.61 days. All patients could be decannulated successfully (mean duration 9.69 days) and 12 could be weaned off feeding tube. None of the patients had any major flap related or donor site complications. Pedicled LD flap has a limited but an effective reconstructive role for extensive buccal cancer ablation as an alternative to free flaps and PMMC in salvage and resource-constrained situations.
游离皮瓣是广泛颊癌切除术后重建的金标准。然而，在先前接受过手术和放疗的颈部进行挽救性手术、成本、手术时间增加以及患者的合并症限制了它们在高容量和资源有限环境中的常规使用。胸大肌肌皮瓣（PMMC）是大型颊部缺损重建的主要手段。然而，在复发的挽救性手术中，当先前的重建中已使用PMMC时，以及在女性患者中，PMMC切取导致供区出现严重并发症时，重建就成为了一项挑战。对2018年7月至2019年9月期间连续13例（8例男性和5例女性）经颊癌切除缺损采用带蒂背阔肌（LD）皮瓣重建的临床资料进行了回顾性分析。使用LD皮瓣的指征包括对先前重建中使用PMMC的复发进行挽救性手术、合并内科疾病、血管耗竭的颈部以及因经济限制而无法使用游离皮瓣。平均随访期为9.84个月。切除术后的平均手术时间为2小时26分钟。平均住院时间为12.61天。所有患者均能成功拔管（平均持续时间9.69天），12例患者可停止使用饲管。所有患者均未出现任何与皮瓣相关的重大并发症或供区并发症。在挽救性手术和资源有限的情况下，带蒂LD皮瓣在广泛颊癌切除术中具有有限但有效的重建作用，可作为游离皮瓣和PMMC的替代方法。
