Wada Mana, Akita Shinsuke, Yasuda Saori, Ikeda Jun-Ichiro, Mitsukawa Nobuyuki
From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Plast Reconstr Surg Glob Open. 2023 May 19;11(5):e5019. doi: 10.1097/GOX.0000000000005019. eCollection 2023 May.
A 59-year-old man with right maxillary cancer presented with a right buccal fistula and an ectropion of the lower eyelid after multidisciplinary treatment. With no suitable vessels in the right face or neck for anastomosis, we planned reconstruction with a free thinned deep inferior epigastric artery perforator flap using the contralateral left facial artery and vein as the recipient. To simulate the length of the vascular pedicle, we used our original software and determined to use the route passing through the nasal cavity. The vascular pedicle was passed through a tunnel from the medial wall of the right maxillary sinus, through the nasal septum and the medial-frontal wall of the left maxillary sinus, to the left facial artery and vein. The flap survived completely, and facial deformity was corrected. At 1 year postoperatively, there had been concerns about the fragility of the vascular pedicle in the nasal cavity and the possibility of easy bleeding. Endoscopic examination revealed that the vascular pedicle in the nasal cavity was covered by fibrous tissue and multirow lineage epithelium, and an excisional biopsy indicated a low possibility of hemorrhage. Cutting off the vascular pedicle to prevent bleeding may not be necessary because the vascular pedicle through the nasal cavity becomes fibrotic and epithelialized in the surrounding area in the long term.
一名59岁的右上颌窦癌男性患者在多学科治疗后出现右侧颊瘘和下眼睑外翻。由于右侧面部或颈部没有合适的血管进行吻合，我们计划使用对侧左面部动静脉作为受区血管，采用游离薄型腹壁下动脉穿支皮瓣进行重建。为模拟血管蒂的长度，我们使用自己开发的软件并确定采用经鼻腔的路径。血管蒂从右上颌窦内侧壁穿过隧道，经鼻中隔和左上颌窦内侧前壁，到达左面部动静脉。皮瓣完全存活，面部畸形得到矫正。术后1年，曾担心鼻腔内血管蒂脆弱及容易出血的可能性。内镜检查显示鼻腔内血管蒂被纤维组织和复层上皮覆盖，切除活检提示出血可能性低。由于经鼻腔的血管蒂长期在周围区域会纤维化并上皮化，可能无需切断血管蒂以防止出血。
