The need for successive free flap applications for soft-tissue reconstruction in a case with recurrent oral carcinoma

Year 2002, Volume: 9 Issue: 6, 430 - 434, 20.12.2002

Ferit Demirkan Emrah Arslan Şakir Ünal Alper Aksoy Murat Ünal

Abstract

A case of difficult oncologic oral reconstruction is illus- trated, in which soft tissue deficits resulting from failure of conventional techniques were treated by successive free tissue transfers. A thirty-eight-year-old man pre- sented with squamous celi carcinoma in the right retrotrigonal region. The tumor was resected and the defect was reconstructed with the use of a tongue flap and skin graft. However, trismus occurred following radiotherapy, which was released by the help of a radial forearm free flap. The patient developed local recur- rence several months later and right hemimandibulec- tomy, total maxillectomy, and hemiglossectomy were performed. The resulting en bloc defect was recon­ structed by a free fibula osteocutaneous flap combined with a pedicled extended pectoralis majör myocuta- neous flap. The pectoralis flap was complicated by partial necrosis resulting in a large orocutaneous fistula and oral commissure incompetence. As the source of either a local or regional flap was inadequate, an anterolateral thigh myocutaneous free flap was used to fiil the maxillary defect. No complications were encountered associated with free tissue transfers and the patient was able to take a soft diet three weeks after the final procedure.

Keywords

Carcinoma, squamous cell/surgery, mouth neoplasms/surgery, neoplasm recurrence, local/surgery, radio­ therapy, adjuvant/adverse effects, reconstructive surgical procedures/methods, surgical flaps/methods/adverse effects

Nüks eden oral karsinomda yumuşak doku eksikliği nedeniyle ardışık serbest flep uygulamaları: Olgu sunumu

Abstract

Bu yazıda konvansiyonel tekniklerle yapılan rekonst- rüksiyonların bir dizi yumuflak doku eksikliği ile sonuç- landığı ve ancak ardıflık serbest flep uygulamaları ile giderilebildiği zor bir onkolojik oral rekonstrüksiyon ol- gusu sunuldu. Otuz sekiz yaflında bir erkek hasta sağ retrotrigonal bölgede yassı hücreli karsinom nedeni ile baflvurdu. Total rezeksiyon uygulanan hastada oluflan defekt, dil flebi ve tam tabaka deri grefti ile onarıldı. An- cak radyoterapi sonrası trismus geliflti ve serbest rad- yal önkol flebi ile trismus açıldı. Bu ameliyatı izleyen aylarda lokal nüks ortaya çıkması üzerine, hastaya sağ hemimandibulektomi, total maksillektomi ve he- miglossektomi uygulandı. Oluflan en bloc defekt vas- külarize fibula osteokütan flep-geniflletilmifl pektoralis majör kas-deri flebi kombinasyonu ile rekonstrükte edildi. Ameliyat sonrası dönemde pektoral flebin dista- linde nekroz ortaya çıkması genifl bir orokutanöz fistül ve oral komisür defekti ile sonuçlandı. Diğer lokal ve rejyonel flep seçenekleri tüketildiği için maksiller defek- tin doldurulması için serbest anterolateral uyluk kas deri flebi kullanıldı. Serbest doku transferine yönelik hiçbir komplikasyon geliflmeyen hastada son serbest flep uygulamasından üç hafta sonra yumuflak gıda alı- mına geçildi

Keywords

Karsinom, skuamöz hücreli/cerrahi, ağızneoplazmları/cerrahi, neoplazm nüksü, lokal/cerrahi, radyoterapi, adjuvan/yan etki, rekonstrüktif cerrahi prosedürler/yöntem, cerrahi flep/yöntem/yan etki

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