大胸筋皮弁を用いた舌・口腔底再建

Reconstruction of the Floor of Mouth Using Pectoralis Major Myocutaneous Flap

　I．はじめに

　最近舌・口腔底再建に大胸筋皮弁pectoralismajor myocutaneous flapを用いる報告が数多くあり，その手術手技が確立されると同時に有用性と安全性が確かめられつつある^{1〜5,7〜9,13,15,16）}。大胸筋皮弁を用いる利点について村上^12）は，①一期的再建が可能である，②経口摂食開始時期が早い，③delayを考慮する必要がない，④皮弁の作図が簡単である，⑤術後の管理が簡単である，⑥皮弁壊死の恐れがないことを挙げているが，これらの利点は頭頸部外科医にとって大きな福音である。

　最近，我々は舌癌3例に対して舌・口腔底切除後大胸筋皮弁を用いた再建を行い，若干の知見を得たので追試報告を行った。

　Three cases of reconstruction of the floor of mouth using pectoralis major myocutaneous flap are reported. All the cases of lingual cancer, T1-T3, had been treated with radiation and chemotherapy,but the tumors were not controlled.

　The floor of mouth was successfuly reconstructed using pectoralis major myocutaneous flap after a subtotal glossectomy (1/2-2/3) with radical neck dissection. In our view points, the important points of using pectoralis major myocutaneous flap are following.

　1) To make a rather large oblong island flap.

　2) To make a wide muscle pedicle in the case of the narrow thoracoacromial artery.

　3) To make 2 layers (epithelium and musculature) sutures between the island flap and the tongue.

　4) The continuous suction drainage is necessary after the operation.