Kagaya Yu, Arikawa Masaki, Sekiyama Takuya, Higashino Takuya, Akazawa Satoshi
Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
J Plast Reconstr Aesthet Surg. 2021 Dec;74(12):3341-3352. doi: 10.1016/j.bjps.2021.05.021. Epub 2021 Jun 6.
BACKGROUND/PURPOSE: After total or subtotal maxillectomy, reconstruction using a free rectus abdominis myocutaneous (RAMC) flap is a fundamental and useful option. The purpose of the present study was to clarify the degree of flap volume change and volume distribution change with time after total or subtotal maxillectomy and free RAMC flap reconstruction and to examine the factors affecting the results.
A total of 20 patients who underwent total or subtotal maxillectomy with free RAMC flap reconstruction were examined, and the flap volume change rate (volume at final evaluation [POD 181-360] / volume at initial evaluation [POD 5-30]) was investigated using the results of imaging tests. Moreover, the flap was divided into four blocks (A-D) in the cranio-caudal direction, and the volume change of each block was individually analyzed.
The overall volume change rate of fat/muscle/total was 0.84 ± 0.21/0.36 ± 0.08/0.67 ± 0.15, at the mean follow-up period of 309±35 days after the operation. The multiple regression analysis revealed that weight loss (for fat), postoperative RT (for fat and muscle), and young age (for muscle) were independently associated with flap volume loss. The results also indicated that the fat volume was stable, whereas the muscle volume decreased to <40% over time, assuming there were no influencing factors. Regarding flap volume distribution change, the fat volume tended to gather toward the central-cranial direction, while the muscle volume gathered toward the cranial direction, and total flap volume gathered toward the central direction.
背景/目的：在全上颌骨切除术或次全上颌骨切除术后，使用游离腹直肌肌皮瓣（RAMC）进行重建是一种基本且有用的选择。本研究的目的是明确全上颌骨切除术或次全上颌骨切除术后及游离RAMC瓣重建后皮瓣体积随时间的变化程度和体积分布变化，并研究影响结果的因素。
共检查了20例行全上颌骨切除术或次全上颌骨切除术并游离RAMC瓣重建的患者，利用影像学检查结果研究皮瓣体积变化率（最终评估时的体积[术后第181 - 360天]/初始评估时的体积[术后第5 - 30天]）。此外，将皮瓣在头 - 尾方向分为四个区域（A - D），并分别分析每个区域的体积变化。
在术后平均随访309±35天，脂肪/肌肉/总体积的总体变化率分别为0.84±0.21/0.36±0.08/0.67±0.15。多元回归分析显示，体重减轻（对于脂肪）、术后放疗（对于脂肪和肌肉）和年轻（对于肌肉）与皮瓣体积减少独立相关。结果还表明，假设没有影响因素，脂肪体积是稳定的，而肌肉体积随时间减少至<40%。关于皮瓣体积分布变化，脂肪体积倾向于向颅中方向聚集，而肌肉体积向颅侧方向聚集，皮瓣总体积向中央方向聚集。
