Hussain A, Dolph J L, Padilla J F, Silver S
Samuel S. Stratton VA Hospital, Albany, NY.
Ann Plast Surg. 1993 Jun;30(6):541-4. doi: 10.1097/00000637-199306000-00013.
Reconstruction after total laryngectomy ideally includes restoration of voice with protected swallowing. Local flaps and tracheo-esophageal puncture with a prosthesis are widely used to accomplish this. Persistent problems, perhaps inherent to this solution, have led to the recent use of a tubed, folded radial forearm free flap for postlaryngectomy reconstruction. This flap has produced a good voice with low phonation pressures and minimal aspiration in 7 patients. A new configuration for this flap is described and 3 patients reported. Our flap's advantages include a simplified pedicle path, ease of construction, remote microanastomosis, and safer revision. Both patients with surviving flaps rapidly developed a good voice after reconstruction. Mild aspiration in 1 delayed oral intake and forced a successful revision. Our reconfigured flap may have some technical advantages, survives to length, and restores a good voice without significant aspiration. This and its simple care make it popular with patients. Development of this flap holds promise of more complete reconstruction after total laryngectomy.
全喉切除术后的重建理想情况下包括恢复发声并保障吞咽功能。局部皮瓣和带假体的气管食管穿刺术被广泛用于实现这一目标。或许是该解决方案固有的持续性问题，导致最近采用带蒂折叠桡侧前臂游离皮瓣进行喉切除术后重建。该皮瓣已使7例患者实现了低声压发声且误吸极少。本文描述了这种皮瓣的一种新构型，并报告了3例患者的情况。我们的皮瓣优点包括蒂部路径简化、易于构建、可在远处进行显微吻合以及修复更安全。两名皮瓣存活的患者在重建后均迅速恢复了良好发声。1例患者出现轻度误吸，延迟了经口进食，并促使成功进行了修复。我们重新构型的皮瓣可能具有一些技术优势，能够存活至足够长度，且能恢复良好发声且无明显误吸。这一点及其护理简单使其受到患者欢迎。这种皮瓣的发展有望在全喉切除术后实现更完整的重建。
