透析患者に対し胸鎖乳突筋皮弁（下方茎）にて再建を行った頭頸部癌の1症例

Reconstruction with an Inferiorly Based Sternocleidomastoid Musculocutaneous Flap for a Head and Neck Cancer Patient under Hemodialysis:A Case Report

　はじめに

　現在，頭頸部癌手術における組織欠損部には，有茎・遊離筋皮弁による再建術が行われ，良好な結果が得られている。しかし，合併症を有する患者に対し，再建を含めた長時間手術を行う場合には周術期管理を十分に配慮し，症例に応じた再建方法を検討する必要がある。

　今回われわれは，人工透析中に，右顎下部に皮膚浸潤を含む扁平上皮癌の患者に対し胸鎖乳突筋皮弁（下方茎）を利用した再建手術を施行し，良好な結果が得られたので若干の文献的考察を加えて報告する。

A 64-year-old man under hemodialysis presented with squamous cell carcinoma of the right submandibu-lar region, and he underwent resection of the tumor combined with segmental mandibulectomy.

The surgical defect was reconstructed with an inferi-orly based sternocleidomastoid musculocutaneous flap. His postoperative course was uneventful, and the func-tions of speech and deglutition were preserved. Although free flap transplantation is often used in recon-strucive surgery of head and neck cancers, it was not applicable to this patient because of his poor general con-dition and association of arteriosclerosis. It was stressed that the application of a sternocleidomastoid musculo-cutaneous flap, a medium-sized pedicle flap, facilitated the radical operation in the present case.