Han Bo, Hao Sen, Han Zhengxue, Fang Jugao, Wu Jixiang
Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Gland Surg. 2022 Jun;11(6):1119-1123. doi: 10.21037/gs-22-319.
Resection of pharyngeal or laryngeal tumors often results in mucosal defects. Which may lead to excessive suture line tension and pharyngocutaneous fistula. The incidence of pharyngocutaneous fistula formation after total laryngectomy is relatively common. In order to reduce the tension of the suture line, a variety of flaps were introduced to repair the defect. Every flap has some defects. For example, the free skin flap may require microvascular anastomosis technology and relatively increase the operation time. The pectoralis major or latissimus dorsi skin flap needs to increase the incision outside the neck region. Therefore, it is very important to design the optimal personalized repair method for specific patients. In this case, in order to minimize the trauma and quickly complete defect repairing, we introduced an innovative application of a pedicled regional flap. To the best of our knowledge, the application of thyroid gland flap (TGF) in this case has not been reported. Meanwhile, it also provides a new option for cervical defect repairing.
In this case report, a 78-year-old male patient complained of "hoarseness for 3 months and dyspnea for 1 week", and was confirmed as having laryngeal squamous cell carcinoma. He underwent total laryngectomy under general anesthesia. After total laryngectomy, the pharyngeal mucosal defect observed was about 2.0 cm × 2.0 cm. Due to the patient's advanced age and relative weakness, a TGF application from the same incision was used to prevent pharyngocutaneous fistula formation following total laryngectomy. The treatment was successful without any associated complications.
In conclusion, a TGF application can be used to repair defects in the neck in selectively suitable cases. The TGF preserving the superior pole vessel can be safely used in mucosal decompression after total laryngectomy.
下咽或喉部肿瘤切除术后常导致黏膜缺损，这可能会导致缝合线张力过大和咽皮肤瘘。全喉切除术后咽皮肤瘘形成的发生率相对较高。为了降低缝合线的张力，人们引入了多种皮瓣来修复缺损。每种皮瓣都有一些不足之处。例如，游离皮瓣可能需要微血管吻合技术，相对增加了手术时间。胸大肌或背阔肌皮瓣需要增加颈部以外区域的切口。因此，为特定患者设计最佳的个性化修复方法非常重要。在本病例中，为了尽量减少创伤并快速完成缺损修复，我们引入了带蒂区域皮瓣的创新应用。据我们所知，甲状腺皮瓣（TGF）在本病例中的应用尚未见报道。同时，它也为颈部缺损修复提供了一种新的选择。
在本病例报告中，一名78岁男性患者主诉“声音嘶哑3个月，呼吸困难1周”，确诊为喉鳞状细胞癌。他在全身麻醉下接受了全喉切除术。全喉切除术后，观察到的咽黏膜缺损约为2.0 cm×2.0 cm。由于患者年龄较大且身体相对虚弱，采用了从同一切口应用甲状腺皮瓣的方法来预防全喉切除术后咽皮肤瘘的形成。治疗成功，未出现任何相关并发症。
总之，在选择性合适的病例中，甲状腺皮瓣可用于修复颈部缺损。保留上极血管的甲状腺皮瓣可安全用于全喉切除术后的黏膜减压。
