Tải xuống
Tóm tắt
Objective: To evaluate the results of soft tissue defect treatment with ALT composite flaps in covering secondary soft tissue defects after radical tumors resection.
Method: From October 2017 to April 2023, we performed a series of 10 single-stage surgeries using composite anterior lateral thigh flap to cover secondary tissue defects in 2 cases covered Achilles tendon defects and 8 cases covered secondary defects after resection of tumors. In all patients with complex, multi-site secondary defects, in patients with secondary defects after resection of the head of the face, the defects are often complex, multi-plane, and multi-site, requiring the use of flaps flexibly and practicably to provide the best postoperative results for the patient. In 10 clinical cases, complex or clustered anterior femoral flaps were selected, and the pedicle and perforating artery branches were identified by hand-held Doppler. The identification of the perforating branches also helps to define the bounds of the flap. The flap is thinned if too thick. Microsurgery anastomosis was performed before the defect was covered.
Result: The size of the ALT flap ranges from 10 x 5cm to 15 x12 cm and the size of the Fascia lata (FL) flap ranges from 7 x 4 cm to 10 x 8 cm. The average peduncle length for skin flap and muscle flap is about 2.5-5 cm and about 3.5- 7 cm, respectively. The thickness of the flap is about 6-13mm. After 3 months of surgery, all flaps are completely alive, close results of flaps are good, distant results are good with stable wound healing, most patients are satisfied with flap color, soft flap site, normal limb function.
Conclusion: The free ALT composite chimeric flaps become a viable and flexible option for single-stage, threedimensional reconstruction of complex organ defects after tumor resection, by reducing the number of surgeries and the number of anastomosis. Improving treatment results for complex defects after cancer resection as well as reduce surgery and treatment time.
Tài liệu tham khảo
Song Y, Chen G, Song Y. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984; 37: 149–159.
Argiris A, Eng C. Epidemiology, Staging, and Screening of Head and Neck Cancer. In: Head and Neck Cancer. Boston: Kluwer Academic Publishers: 15–60.
Homer JJ, Fardy MJ. Surgery in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016; 130: S68–S70.
Longo B, Nicolotti M, Ferri G, Belli E, Santanelli F. Sagittal Split Osteotomy of the Fibula for Modeling the New Mandibular Angle. Journal of Craniofacial Surgery. 2013; 24: 71–74.
Kim HS, Chung CH, Chang YJ. Free-flap reconstruction in recurrent head and neck cancer: A retrospective review of 124 cases. Arch Craniofac Surg. 2020; 21: 27–34.
Homer JJ, Fardy MJ. Surgery in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016; 130: S68–S70.
Zhang C, Sun J, Zhu H et al. Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps. Int J Oral Maxillofac Surg. 2015; 44: 675–684.
Argiris A, Eng C. Epidemiology, Staging, and Screening of Head and Neck Cancer. In: Head and Neck Cancer. Boston: Kluwer Academic Publishers: 15–60.
Son TT, Dung PTV, Thuy TTH, Chien VH, Phuc LH, Huy LA. One-stage reconstruction of the massive overlying skin and Achilles tendon defects using a free chimeric anterolateral thigh flap with fascia lata. Microsurgery. 2022; 42: 659–667.
Shieh S-J, Chiu H-Y, Yu J-C, Pan S-C, Tsai S-T, Shen C-L. Free Anterolateral Thigh Flap for Reconstruction of Head and Neck Defects following Cancer Ablation. Plast Reconstr Surg. 2000; 105: 2349–2357.
Kuo Y-R, Jeng S-F, Kuo M-H, Liu Y-T, Lai P-W. Versatility of the Free Anterolateral Thigh Flap for Reconstruction of Soft-Tissue Defects: Review of 140 Cases. Ann Plast Surg. 2002; 48: 161–166.
Choi S-W, Park J-Y, Hur M-S et al. An Anatomic Assessment on Perforators of the Lateral Circumflex Femoral Artery for Anterolateral Thigh Flap. Journal of Craniofacial Surgery. 2007; 18: 866–871.
Shieh S-J, Chiu H-Y, Yu J-C, Pan S-C, Tsai S-T, Shen C-L. Free Anterolateral Thigh Flap for Reconstruction of Head and Neck Defects following Cancer Ablation. Plast Reconstr Surg. 2000; 105: 2349–2357.
Kawakita D, Oze I, Iwasaki S, Matsuda T, Matsuo K, Ito H. Trends in the incidence of head and neck cancer by subsite between 1993 and 2015 in Japan. Cancer Med. 2022; 11: 1553–1560.
Wang Y, Wang S, Qu Y, Yang Y. Clinicopathological characteristics, treatment and prognosis of oral adenocarcinoma: a population-based study. European Archives of Oto-Rhino-Laryngology. 2023; 280: 3365–3374.
Lin DT, Coppit GL, Burkey BB. Use of the anterolateral thigh flap for reconstruction of the head and neck. Curr Opin Otolaryngol Head Neck Surg. 2004; 12: 300–304.
Wong C-H, Wei F-C. Microsurgical free flap in head and neck reconstruction. Head Neck. 2010; 32: 1236–1245.
Koshima I. Free Anterolateral Thigh Flap for Reconstruction of Head and Neck Defects following Cancer Ablation by Shyh-Jou Shieh, M.D., Haw-Yen Chiu, M.D., Jui-Chin Yu, M.D., Shin-Chen Pan, M.D., Sen-Tien Tsai, M.D., and Ching-Liang Shen, Ph.D. Plast Reconstr Surg. 2000; 105: 2358–2360.
Jiang C, Guo F, Li N et al. Multipaddled Anterolateral Thigh Chimeric Flap for Reconstruction of Complex Defects in Head and Neck. PLoS One. 2014; 9: e106326
| Đã xuất bản | 28-12-2024 | |
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| Số tạp chí | Số 95 (2024) | |
| Phân mục | Nghiên cứu | |
| DOI | 10.38103/jcmhch.95.3 | |
| Từ khóa | ALT flap, composite flap, ALT chimeric flap, secondary defect |
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