구개상악재건을 위한 유리피판술에서 다양한 공여부의 선택

Selection of Various Free Flap Donor Sites in Palatomaxillary Reconstruction

  • 윤도원 (연세대학교 원주의과대학 성형외과교실) ;
  • 민희준 (연세대학교 원주의과대학 성형외과교실) ;
  • 김지예 (연세대학교 원주의과대학 성형외과교실) ;
  • 이원재 (연세대학교 의과대학 성형외과교실) ;
  • 정섬 (국민건강보험공단 일산병원) ;
  • 정윤규 (연세대학교 원주의과대학 성형외과교실)
  • Yoon, Do-Won (Department of Plastic and Reconstructive Surgery Yonsei University, Wonju College of Medicine) ;
  • Min, Hee-Jun (Department of Plastic and Reconstructive Surgery Yonsei University, Wonju College of Medicine) ;
  • Kim, Ji-Ye (Department of Plastic and Reconstructive Surgery Yonsei University, Wonju College of Medicine) ;
  • Lee, Won-Jae (Department of Plastic and Reconstructive Surgery Yonsei University, College of Medicine) ;
  • Chung, Seum (National Health Insurance Corporation Ilsan Hospital) ;
  • Chung, Yoon-Kyu (Department of Plastic and Reconstructive Surgery Yonsei University, Wonju College of Medicine)
  • 발행 : 2011.05.31

초록

Purpose: A palatal defect following maxillectomy can cause multiple problems like the rhinolalia, leakage of foods into the nasal cavity, and hypernasality. Use of a prosthetic is the preferred method for obturating a palate defect, but for rehabilitating palatal function, prosthetics have many shortcomings. In a small defect, local flap is a useful method, however, the size of flap which can be elevated is limited. In 12 cases of palatomaxillary defect, we used various microvascular free flaps in reconstructing the palate and obtained good functional results. Method: Between 1990 and 2004, 12 patients underwent free flap operation after head and neck cancer ablation, and were reviewed retrospectively. Among the 12 free flaps, 6 were latissimus dorsi myocutaneous flaps, 3 rectus abdominis myocutaneous flaps, and 3 radial forearm flaps. Result: All microvascular flap surgery was successful. Mean follow up time was 8 months and after the follow up time all patients reported satisfactory speech and swallowing. Wound dehiscence was observed in 4 cases, ptosis was in 1 case and fistula was in 1 case, however, rhinolalia, leakage of food, or swallowing difficultly was not reported in the 12 cases. Conclusion: We used various microvascular flaps for palatomaxillary reconstruction. For 3-dimensional flap needs, we used the latissimus dorsi myocutaneous flap to obtain enough volume for filling the defect. Two-dimensional flaps were designed with latissimus dorsi myocutaneous flap, rectus abdominis flap and radial forearm flap. For cases with palatal defect only, we used the radial forearm flap. In palatomaxillary reconstruction, we can choose various free flap techniques according to the number of skin paddles and flap volume needed.

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