頸部Island Skin Flap変法による口腔内悪性腫瘍摘出後の一次的再建

PRIMARY RECONSTRUCTION FOLLOWING RESECTIN OF INTRAORAL CANCER BY MODIFIED CERVICAL ISLAND FLAP

　I．はじめに

　下顎，口腔底などの口腔内悪性腫瘍摘出後の再建には，（1）1次縫合の場合，過大張力による縫合不全や瘻孔形成，（2）瘢痕収縮や縫縮による舌運動障害などの機能障害，（3）2次形成の場合の長期化，（4）瘻孔形成に伴う頸動脈露出とその破裂の危険性などの問題点がある。また，最近は初回治療を放射線で行なう場合が多くなつてきているので，縫合不全による痩孔形成の機会がより多くなつてきているようである。

　以上のような問題点を解消する1次的再建法として，Farr^1）の原法を修飾した側頸部島状皮弁変法（modified latcral cervical island skin flap method）はすでに発表した^2）が，今回はその症例を追加し，さらにDesprez^3）のdirect apron flapを修飾した正中頸部島状皮弁変法（modified median cervical island skin flap method）を用いた再建例を加えた13例について報告する。

　Reconstruction of the oral defect following cancer surgery often causes formation of fistula, impiarment of lingual movement, prolonged hospitalization by secondary reconstruction and danger of rupture of the carotid artery due to fistula. To reduce such complications, modified cervical island skin flap as one stage reconstruction of intraoral repair (within 6×6cm²) was used on 13 patients suffering from cancer on the floor of the mouth, gum and mandible. The lateral and median cervical island flaps were pedicled with the fat and platysma. The epidermis, denuded to make the island flap was not cut off, but preserved by the pedicle on the posterior neck in order to ease the neck closure. This is a modified point.

　Lateral cervical island flap was used in 10 cases and the median flap in 3. These method proved to be successful for 12 patients. One patient who recieved a preoperative full dose of irradiation had a partial necrosis on the tip of the flap that resulted in a fistula. There were two types of healing of the skin flap. The post-operative external appearance and function of the tongue were commendable.