CAJ | 학술논문

目的对采用游离肩胛骨肌皮瓣修复上颌骨缺损进行初步探讨.方法选择因鼻窦或口腔肿瘤需行外科手术,将导致颌面中部软、硬组织缺损,严重影响功能需要修复的4例患者,其中造釉细胞瘤、低度恶性黏液表皮样癌术后复发、颌骨肉瘤及鳞状细胞癌各1例.采用游离肩胛骨肌皮瓣进行口腔颌面复合缺损的三维修复.结果 4例患者伤口均于术后2周愈合,3周左右顺利进食半流质饮食,1个月后语言交流清楚,2个月后随着组织水肿消退,3例配带义齿,颌面轮廓接近原貌,咀嚼功能部分恢复.l例上颌骨肉瘤患者术后9个月咽旁颅底再次肿瘤复发并肺转移,患者未再接受治疗,1年后死亡;其他3例分别随诊37、25、10个月,目前未见肿瘤复发.患者肩背供瓣区无明显功能障碍.CT、骨扫描显示移植骨血供良好.结论肩胛骨肌皮瓣具有血供可靠、切口隐蔽、供区功能影响小的特点,可供组织种类和组织量多,其骨瓣适形性及可塑性优于其他游离移植组织,是修复面部上颌骨复合缺损的一种比较满意的方法,但是种植体需要的骨基可能逊色于腓骨,另外手术过程中需要变换体位从而会延长手术时间.
목적 대채용유리견갑골기피판수복상합골결손진행초보탐토.방법 선택인비두혹구강종류수행외과수술,장도치합면중부연、경조직결손,엄중영향공능수요수복적4례환자,기중조유세포류、저도악성점액표피양암술후복발、합골육류급린상세포암각1례.채용유리견갑골기피판진행구강합면복합결손적삼유수복.결과 4례환자상구균우술후2주유합,3주좌우순리진식반류질음식,1개월후어언교류청초,2개월후수착조직수종소퇴,3례배대의치,합면륜곽접근원모,저작공능부분회복.l례상합골육류환자술후9개월인방로저재차종류복발병폐전이,환자미재접수치료,1년후사망;기타3례분별수진37、25、10개월,목전미견종류복발.환자견배공판구무명현공능장애.CT、골소묘현시이식골혈공량호.결론 견갑골기피판구유혈공가고、절구은폐、공구공능영향소적특점,가공조직충류화조직량다,기골판괄형성급가소성우우기타유리이식조직,시수복면부상합골복합결손적일충비교만의적방법,단시충식체수요적골기가능손색우비골,령외수술과정중수요변환체위종이회연장수술시간.
Objective Preliminary study on free scapula osteomyocutaneous flap to repair maxillary defect.Methods Central maxillofacial soft and hard tissue defect after nasal sinus or oral tumor surgery was repaired with free scapual osteomyocutaneous flap in 4 patients to reconstruct their maxillofacial functions.The primary tumors included an ameloblastoma, a recurrent low-grade mucous epidermoid carcinoma a jaw sarcoma and a squamous cell carcinoma.Results All the 4 cases had good wound healing within 2 weeks after surgery, with no complications, could take in semifluid food after 3 weeks, and had clear language communication after 1 month.Three cases wore denture after 2 months and recovered maxillofacial contour and partial chewing function, and had no tumor recurrences with the follow-up of 37, 25 and 10 months respectively.One case of maxilla sarcomas had recurrence with invasion of parapharyngeal space and skull base and pulmonary metastasis 9 months after surgery, who gave up further treatment and died 1 year later.No obvious dysfunction occurred in shoulder and back donation sites and well blood supply in transplanted bones were showed with CT and bone scan.Conclusions Scapula osteomyocutaneous flap has some advantages including reliable blood supply, hidden incision and little affect on the donation site, and it can apply with multiple tissues including bone, muscle, and skin for repair.This flap also has good shape adaptability and availability.So scapula osteomyocutaneous flap is a satisfactory method for the repair of facial maxillary complex defects.But some limitations exist in the flap, by which less amount of bone can be applied and more operation time is required due to the changes of patient's body position during surgery.