대한치과의사협회지 (The Journal of the Korean dental association)

  • 제49권9호
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  • Pages.527-534
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  • 2011
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  • 0376-4672(pISSN)
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  • 2713-7961(eISSN)
대한치과의사협회 (The Korean Dental Association)
권호 표지

상악결손부의 2차적 재건에 있어 유리 혈관화 피판의 적용

Late reconstruction of oncological maxillary defect with microvascular free flap

  • 권대근 (경북대학교 치의학 전문대학원, 구강악안면외과학교실) ;
  • 김진수 (경북대학교 치의학 전문대학원, 구강악안면외과학교실)
  • Kwon, Tae-Geon (Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyungpook National University) ;
  • Kim, Chin-Soo (Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyungpook National University)
  • 발행 : 2011.09.01
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초록

Microvascular reconstruction of maxillary composite defect after oncologic resection has improved both esthetic and functional aspect of quality of life of the cancer patients. However, a lot of patients had prior surgery with radiation and/or chemotherapy as a part of comprehensive cancer treatment. Sometimes it is nearly impossible to find out adequate recipient vessel for maxillary reconstruction with microvascular anastomosis. Therefore long pedicle of the flap is needed to use distant neck vessels located far from the reconstruction site such as ipsilateral transverse cervical artery or a branch of contralateral external carotid artery. For this reason, although we know the treatment of the choice is osteocutaneous flap, it is difficult to use this flap when we need long pedicle with complex three dimensional osseous defect. Vascular option for these vessel-depleted neck patients can be managed by a soft tissue reconstruction with long vascular pedicle and additional free non-vascularized flap that is rigidly fixed to remaining skeletal structures. For this reason, maxillofacial reconstruction by vascularized soft tissue flap with or without the secondary restoration of maxillary bone with non-vascularized iliac bone can be regarded as one of options for reconstruction of profound maxillofacial composite defect resulted from previous oncological resection with chemo-radiotherapy.

키워드

참고문헌

  1. Dalgorf 0, Higgins K. Reconstruction of the midface and maxilla.Curr Opin Otolaryngol Head Neck Surg. 2008; 16:303-11. https://doi.org/10.1097/MOO.0b013e328304b426
  2. McCarthy CM, Cordeiro PO. Microvascular reconstruction of oncologic defects of the midface. Plast Reconstr Surg. 2010;126:1947-59. https://doi.org/10.1097/PRS.0b013e3181f446f1
  3. Liu YM, Chen OF, Yan JL, Zhao SF, Zhang WM, Zhao S. Functional reconstruction of maxilla with pedicled buccal fat pad flap, prefabricated titanium mesh and autologous bone grafts. Int J Oral Maxillofac Surg 2006; 35; 1108-13. https://doi.org/10.1016/j.ijom.2006.09.012
  4. Futran NO, Wadsworth JT, Villaret 0, Farwell DO. Midface reconstruction with the fibula free flap. Arch Otolaryngol Head Neck Surg. 2002; 128: 161-166. https://doi.org/10.1001/archotol.128.2.161
  5. Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck 1996;18:412-21. https://doi.org/10.1002/(SICI)1097-0347(199609/10)18:5<412::AID-HED4>3.0.CO;2-8
  6. Oranick MS, Ramasastry SS, Newton ED, Solomon MP, Hanna DC, Kaltman S. Reconstruction of complex maxillectomy defects with the scapularfree flap. Head Neck 1990;12:377-85. https://doi.org/10.1002/hed.2880120502
  7. Chepeha DB, Moyer JS, Bradford CR, Prince ME, Marentette L. Teknos TN. Osseocutaneous radial forearm free tissue transfer for repair of complex midfacial defects. Arch Otolaryngol Head Neck Surg. 2005;131 :513-517. https://doi.org/10.1001/archotol.131.6.513
  8. Amin A, Rifaat M, Civantos F, Weed D, Abu-Sedira M, Bassiouny M. Free anterolateral thigh flap for reconstruction of major craniofacial defects. J Reconstr Microsurg. 2006; 22: 97-104. https://doi.org/10.1055/s-2006-932503
  9. Bras J, de Jonge HK, van Merkesteyn JP. OsteoradionecroSis of the mandible: pathogenesis. Am J Otolaryngol. 1990 Jul-Aug;11(4):244-50. https://doi.org/10.1016/0196-0709(90)90084-9
  10. Schliephake H. Revascularized tissue transfer for the repair of complex midfacial defects in oncologic patients. J Oral Maxillofac Surg. 2000 ;58: 1212-1218. https://doi.org/10.1053/joms.2000.16616
  11. Obwegeser HL. Late reconstruction of large maxillary defects after tumour resection. J Maxillofac Surg 1973 ; 1: 19-23. https://doi.org/10.1016/S0301-0503(73)80008-6
  12. Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg. 2000; 105: 2331-2346; discussion 2347-2348. https://doi.org/10.1097/00006534-200006000-00004
  13. Mucke T, Loeffelbein DJ, Hohlweg-Majert S, Kesting MR, Klaus-Dietrich W, Holzle F. Reconstruction of the maxilla and midface - Surgical management, outcome, and prognostic factors. Oral Oncology 2009;45: 1073-8. https://doi.org/10.1016/j.oraloncology.2009.10.003
  14. Wong KK, Higgins KM, Enepekides DJ. Microvascular reconstruction in the vessel-depleted neck.Curr Opin Otolaryngol Head Neck Surg. 2010; 18: 223-6. https://doi.org/10.1097/MOO.0b013e32833a2e50
  15. Sanger JR, Yousif NJ, Matloub HS, Larson DL, Sewall SS. Reconstruction of lower third of face with three simultaneous free flaps. Plast Reconstr Surg. 1994 Oct;94(5):709-13. https://doi.org/10.1097/00006534-199410000-00023
  16. He Y, Zhu HG, Zhang lV, He J, Sader R. Threedimensional model simulation and reconstruction of composite total maxillectomy defects with fibula osteomyocutaneous flap flow-through from radial forearm flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: e6-12. https://doi.org/10.1016/j.tripleo.2009.07.027
  17. Cordeiro PG, Sacilious N, Schantz S, Spiro R. The radial forearm osteocutaneous "sandwich" free flap for reconstruction of the bilateral subtotal maxillectomy defect. Ann Plast Surg. 1998; 40: 397- 402. https://doi.org/10.1097/00000637-199804000-00013
  18. Pollice PA, Frodel IL Jr. Secondary reconstruction of upper midface and orbit after total maxillectomy. Arch Otolaryngol Head Neck Surg 1998; 124: 802-8. https://doi.org/10.1001/archotol.124.7.802
  19. Cordeiro PG, Santamaria E, Kraus DH, Strong EW, Shah JP. Reconstruction of total maxillectomy defects with preservation of the orbital contents. Plast Reconstr Surg. 1998; 102: 1874-1884; discussion 1885-1887. https://doi.org/10.1097/00006534-199811000-00011
  20. Sarukawa S, Okazaki M, Asato H, Koshima I. Volumetric changes in the transferred flap after anterior craniofacial reconstruction. J Reconstr Microsurg. 2006; 22: 499-505; discussion 506-507. https://doi.org/10.1055/s-2006-951313