Tsao Chung-Kan, Kudva Adarsh, Cheong David Chon-Fok, Hung Shao-Yu
Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing St. Kuei-Shan, Taoyuan, Taiwan.
Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
J Maxillofac Oral Surg. 2022 Jun;21(2):358-368. doi: 10.1007/s12663-022-01704-7. Epub 2022 Mar 10.
Appropriate concepts of reconstruction can eliminate contraindications, reduce the incidence of complications, increase the success rates, and promote the outcomes. Besides, appropriate concepts can also help economical use of expensive technology or assistant tools on the patients who are necessary and beneficial. This paper provides a comprehensive approach to select reconstructive methods for oral defects following ablative surgery. A comprehensive approach should have a thorough understanding of the reconstructive goals, the patient's information, the surgeon's ability, and the hospital's support. To achieve a basic structural and functional restoration of oral cavity, "reconstruction ladder" could be skipped to free flap transfer. Goal-oriented thinking process with rethinking the feasibility assessment can help the surgeon to find the most appropriate method of reconstruction. Appropriate methods can mostly achieve the above-average results and rarely lead to inadequate results. Current concepts for reconstruction of oral tissue are the balance between maximal outcome and minimal complication, maximal accuracy and minimal cost, maximal efficacy and minimal investment. A comprehensive approach to select flap, a reliable method to harvest flap, and a customized flap design/inset are keystones to achieve a relatively better outcome. The awesome of limitations from the surgeon's ability, hospital's support, and the patient's condition can minimize the complications.
恰当的重建理念可以消除禁忌证,降低并发症发生率,提高成功率,并改善治疗效果。此外,恰当的理念还有助于在对患者必要且有益的情况下经济地使用昂贵的技术或辅助工具。本文提供了一种为口腔切除术后缺损选择重建方法的综合途径。一种综合途径应全面了解重建目标、患者信息、外科医生的能力以及医院的支持情况。为实现口腔的基本结构和功能恢复,可跳过“重建阶梯”直接进行游离皮瓣移植。以目标为导向的思维过程并重新思考可行性评估,有助于外科医生找到最合适的重建方法。恰当的方法大多能取得高于平均水平的效果,很少导致效果不佳。当前口腔组织重建的理念是在最大治疗效果与最小并发症、最大准确性与最小成本、最大疗效与最小投入之间取得平衡。选择皮瓣的综合途径、可靠的皮瓣切取方法以及定制的皮瓣设计/植入是取得相对较好治疗效果的关键。认识到外科医生能力、医院支持和患者病情的局限性,可将并发症降至最低。