有茎弁による頭頸部腫瘍の一次的形成手術—第4報 血管茎弁による小欠損の修復

PRIMARY RECONSTRUCTIVE SURGERY WITH PEDICLED FLAP AFTER RESECTION OF HEAD AND NECK TUMOR

　I．はじめに

　頭頸部腫瘍の摘除手術によつて生ずる欠損は，単に美容上問題となるだけでなく，ほとんどの場合，呼吸，そしゃく，嚥下，構音などの機能的障害を残すものである。したがつて，なるべく早期に，できれば一次的に欠損部分を修復して生理機能の再建を計ることが治癒を促進し，精神的充実感をもたらし，ひいては社会復帰への足掛りを与えることからも治療上の重要な点となつてくる。

　腫瘍に対する外科的治療は破壊手術に通ずるという考え方はすでに過去のものであつて，生理機能を保存する部分切除法の開発改良に併行して，広範囲手術と一次的形成手術つまり根治と機能再建を計る手術方法が研究されねばならぬと信ずるものである。

　Following exterpation of head and neck tumors, attempts were made for functional reconstruction of smaller defects by employing several kinds of vascular pedicled island flaps. Following conclusions are reached:

　1) Vascular pedicled island flap derived from the superficial temporal artery is highly effective in that it could be used in any region within the range of 10 cm from the preauricular area and the take is satisfactory even to site that had been preoperatively irradiated.

　2) The island flap made from the supratrochlear artery in the midportion of the forehead, on the other hand, is useful only in the upper external area of the nose because its range of extension is short and the cliber of the blood stream is poor.

　3) Mucoperiosteal island flap from the hard palate with the great palatine artery is quite satisfactory in repairing a small defect in the soft palate. However, it may fail to take because of circulatory disturbances that may be present after irradiation or in elderly patients.