Girotto Riccardo, Monarchi Gabriele, De Feudis Francesco, Paglianiti Mariagrazia, Balercia Paolo
Division of Maxillofacial Surgery, Department of Neurological Sciences, University Hospitals of Ancona, Ancona, Italy.
Department of medicine, Section of maxillo-facial surgery, University of Siena, Viale Bracci, Siena, 53100 Italy.
Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):2829-2835. doi: 10.1007/s12070-023-03870-7. Epub 2023 May 17.
Microsurgical reconstruction is nowadays the treatment of choice of several head and neck deformities that otherwise could be repaired with limited or unsatisfactory results. The forearm free flap has its own goals expecially the possibility to reconstruct small and extremely specialized anatomical structures such as the soft palate. The abuse of drugs like cocaine, generally taken by sniffing, can produce vascular impairment in nasal and oral tissues producing, as long as the abuse is kept, necrosis of facial anatomical structures and increase of the empty space in the depth of the face or nose. The consequences are generally represented by palatal fistulas or defect, leak of food or drink from the nose, and rhinolalia. Prelamination of the flap before microvascular transfer ensures not only preparation ofadequate tissue volume to resurface the defect but also optimization of the venous outflow. This two times approach, consisting first in preparation and then elevation/transfer of the flap, gives the chances to ensure viability of the flap itself and organize the surgical strategy several times to reduce forthcoming complications. The authors believe that this technical modification could be used for many other chronic defects in the head and neck region but could also be extended, with experience, to bigger defects.
The online version contains supplementary material available at 10.1007/s12070-023-03870-7.
如今，显微外科重建是治疗多种头颈部畸形的首选方法，否则这些畸形可能只能得到有限或不尽人意的修复效果。前臂游离皮瓣有其自身的目标，特别是重建诸如软腭等小而极其特殊的解剖结构的可能性。滥用可卡因等通常通过吸食摄入的药物，会导致鼻和口腔组织的血管损伤，只要滥用持续，就会导致面部解剖结构坏死，并增加面部或鼻腔深部的空隙。其后果通常表现为腭瘘或缺损、食物或饮料从鼻子漏出以及鼻音。在微血管转移前对皮瓣进行预分层，不仅能确保准备足够的组织量来覆盖缺损，还能优化静脉流出。这种分两步走的方法，首先是准备皮瓣，然后是掀起/转移皮瓣，有机会确保皮瓣本身的存活，并多次规划手术策略以减少即将出现的并发症。作者认为，这种技术改进可用于头颈部区域的许多其他慢性缺损，随着经验的积累，也可扩展到更大的缺损。
在线版本包含可在10.1007/s12070-023-03870-7获取的补充材料。
