구강 결손부에 적용된 요골 유리전완 피부피판 적용례 분석 (Clinical Cases Analysis of Forearm Free Fasciocutaneous Flaps on Oral Cavity Defect Area)

서지정보

· 발행기관 : 대한악안면성형재건외과학회
· 수록지 정보 : Maxillofacial Plastic Reconstructive Surgery / 32권 / 4호 / 324 ~ 331페이지
· 저자명 : 김욱규, 이광호, 송원욱, 황대석, 김용덕, 신상훈, 김종렬, 정인교

초록

The radial forearm free flap (RFFF) has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. We have transferred 12 RFFFs with fasciocutaneous type on oral cavity defects in 12 patients after cancer resection and submucous fibrotic lesion ablation from 2005 to 2007 at Department of oral and maxillofacial surgery, Pusan National University Hospital. We reviewed retrospectively patients' charts and followed up the patients. Clinical analysis on the cases with RFFFs focusing on flap morbidity, indications and available vessels was done. The results of study are follows:1. RFFF could be applied for all kind of defects after resection of tongue, floor of mouth, buccal mucosa,denuded bone of palate, maxilla, and mandible.
2. All free flaps could be used for primary reconstruction. The survival rate of 12 RFFFs was 92%. Partial marginal loss of the flaps was shown as 3 cases among 12 cases. Large size-vessels like superior thyroid artery, facial artery, internal jugular vein were favorable for microvascular anastomosis.
3. Parenteral nutrition instead of nasal L-tube also can be favorable for postoperative a week for better healing of the flap if the patients couldn't be tolerable with nasal tubing.
4. Donor sites with thigh skin graft were repaired with wrist band for 2 weeks. The complications included scarring, abnormal sensation on hand, and reduced grip strength in few patients, but those didn't induce major side effects.
5. Most RFFFs were well healed even if mortality rate of cancer patients was shown as 50% (5/10 persons).
The mortality of patients was not correlated with morbidity of the flaps. We could identify the usefulness of RFFF for restoration of oral function, esthetics if the flap design, tissue transfer indications,and well controlled operation are proceeded.

영어초록

The radial forearm free flap (RFFF) has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. We have transferred 12 RFFFs with fasciocutaneous type on oral cavity defects in 12 patients after cancer resection and submucous fibrotic lesion ablation from 2005 to 2007 at Department of oral and maxillofacial surgery, Pusan National University Hospital. We reviewed retrospectively patients' charts and followed up the patients. Clinical analysis on the cases with RFFFs focusing on flap morbidity, indications and available vessels was done. The results of study are follows:1. RFFF could be applied for all kind of defects after resection of tongue, floor of mouth, buccal mucosa,denuded bone of palate, maxilla, and mandible.
2. All free flaps could be used for primary reconstruction. The survival rate of 12 RFFFs was 92%. Partial marginal loss of the flaps was shown as 3 cases among 12 cases. Large size-vessels like superior thyroid artery, facial artery, internal jugular vein were favorable for microvascular anastomosis.
3. Parenteral nutrition instead of nasal L-tube also can be favorable for postoperative a week for better healing of the flap if the patients couldn't be tolerable with nasal tubing.
4. Donor sites with thigh skin graft were repaired with wrist band for 2 weeks. The complications included scarring, abnormal sensation on hand, and reduced grip strength in few patients, but those didn't induce major side effects.
5. Most RFFFs were well healed even if mortality rate of cancer patients was shown as 50% (5/10 persons).
The mortality of patients was not correlated with morbidity of the flaps. We could identify the usefulness of RFFF for restoration of oral function, esthetics if the flap design, tissue transfer indications,and well controlled operation are proceeded.

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