두피에 생긴 광범위한 편평세포암의 수술적 치료로써 유리피판술의 증례 (Free flap coverage for extensive squamous cell carcinoma in scalp : case report)

서지정보

· 발행기관 : 대한두개저학회
· 수록지 정보 : 대한두개저학회지 / 8권 / 1호 / 13 ~ 16페이지
· 저자명 : 윤지영, 김은기

초록

Wide excision of extensive sq cc in scalp often requires free flap for adequate coverage.
Various flaps can be considered depending on the size of the defect, donor site morbidity, or surgeon preferences etc. Here we report a case of extensive squamous cell carcinoma in scalp initially covered with free LD flap, which eventually required a free VRAM flap with wide skin paddle after severe atrophy of muscle portion probably due to adjuvant radiation.
51 year-old female was diagnosed SCC on three fourths of scalp. After wide excision, LD free flap was performed to cover the defect. After three months later, SCC was reccured on the skull, so artificial bone graft was performed with partial elevation of the previous LD flap.
The patient underwent adjuvant radiation and developed a few events of infection afterwards. Infection finally subsided but artificial bone was exposed at thinned LD muscle portion. Finally a free VRAM flap covered the defect. There was no significant complication such as flap necrosis or fat necrosis. The VRAM flap was well maintained throughout the follow-up period. Postoperative radiotherapy could cause severe atrophy of a muscle flap and a thin muscle flap like LD might even develop full thickness defect. In such situation a MC flap with larger skin peddle and small muscle flap such as TRAM or VRAM would be a better option than a MC flap with small skin paddle and thin wide muscle such as LD.

영어초록

Wide excision of extensive sq cc in scalp often requires free flap for adequate coverage.
Various flaps can be considered depending on the size of the defect, donor site morbidity, or surgeon preferences etc. Here we report a case of extensive squamous cell carcinoma in scalp initially covered with free LD flap, which eventually required a free VRAM flap with wide skin paddle after severe atrophy of muscle portion probably due to adjuvant radiation.
51 year-old female was diagnosed SCC on three fourths of scalp. After wide excision, LD free flap was performed to cover the defect. After three months later, SCC was reccured on the skull, so artificial bone graft was performed with partial elevation of the previous LD flap.
The patient underwent adjuvant radiation and developed a few events of infection afterwards. Infection finally subsided but artificial bone was exposed at thinned LD muscle portion. Finally a free VRAM flap covered the defect. There was no significant complication such as flap necrosis or fat necrosis. The VRAM flap was well maintained throughout the follow-up period. Postoperative radiotherapy could cause severe atrophy of a muscle flap and a thin muscle flap like LD might even develop full thickness defect. In such situation a MC flap with larger skin peddle and small muscle flap such as TRAM or VRAM would be a better option than a MC flap with small skin paddle and thin wide muscle such as LD.

참고자료

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