舌癌術後一次的再建における胸鎖乳突筋皮弁の応用

Use of the Sternomastoid Myocutaneous Flaps for the Immediate Repair of Surgical Defects of Tongue Cancer

　I．はじめに

　頭頸部癌切除後の形態と機能の再建に各種皮弁が用いられ，十分な安全域をつけた腫瘍の切除が可能となった。ここに報告する胸鎖乳突筋皮弁（SMと略す）は，Pedicle axial vascular Patternmyocutaneous flapに属し，血行が良好で生着の確実な皮弁とされている。これの利用は，Owens^1）にはじまり，約8年の空白後，Bakamjian^2），Littlewood^3），O'Brien^4）にひきつがれ，近年Jabaley^5），McCraw^6），Ariyan^7,8），Sasaki^9），Toomey^10），筆者^11），村上^12），窪田^13）らの報告があるが，同じmyocutaneous flapでも，pcctoralis major（PM）やlatissimus dorsi（LD）に比し報告が少ない。筆者らは，今回5例の口腔咽頭切除後の再建にこのflapを用いて，ほぼ満足する成績を得た。まだ少数例の，日の浅い経験であるが，その特徴を概述する。

　By the use of the sternomastoid musculocutaneous flap, we have successfully reconstructed the surgical defect after extended radical operation of 5 cases of tongue cancer. The present experiences indicated that its advantages are the improved viability of the flap due to good blood supply of axial vascular pattern, augmentation of the mass substituted for the tongue and oral floor diaphragmadueto an adequate bulk of the muscle, length of the skin flap enough to provide the coverage of the massive oral and mesopharyngcal defects with good rotation arch, simple and easy procedure under the surgical field same as that for primary lesion, capabilities for one-stage reconstruction, andminimum functional and cosmetic disturbance of the donor site.

　When upper radical neck dissection on one side is required or the carotid artery has already been ligated, either an ipsilateral inferior based flap or a contralateral flap must be employed.