重度顔面先天異常（顔面裂）に対する再建手術と最終touch up surgery

Final Touch-Up Surgery for Severe Facial Clefts with Extensive Tissue Defect

はじめに

　顔面の先天異常で特に重度の顔面裂には，大きな問題点が2つある。1つは，裂隙部に広範な組織欠損があり，皮膚・軟部組織だけでなく硬組織も大きく欠損していることである。もう1つは，小児において遊離皮弁を採取し顔面の欠損部に確実に生着させることが容易ではないこと，また皮弁採取部に成長障害を来たす可能性があることである。

　本稿では，これら2つの問題点に対して著者らが行ってきた治療方針ならびに実際の手術戦略と手技について報告する。

　Two cases of severe facial clefts with extensive tissue defect were successfully reconstructed using a local flap harvested from the patientsʼ submental region. In pediatric cases, sufficient volumes of skin and soft tissue are required at the time of a final touch-up surgery in order to achieve a satisfactory functional and morphological reconstruction according to the growth changes of the childʼs face. This method is very useful for two reasons: (i) it allows the transplantation of voluminous skin and soft tissue to the face while preserving blood flow, and (ii) the flap has excellent facial color and texture match. Especially in children, in whom the craniofacial area accounts for a large proportion of the body trunk, the facial reconstruction technique using a local flap harvested from the submental area is a safe and logical procedure.