Nüks eden oral karsinomda yumuşak doku eksikliği nedeniyle ardışık serbest flep uygulamaları: Olgu sunumu
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
Anahtar Kelimeler:
Karsinom, skuamöz hücreli/cerrahi, ağızneoplazmları/cerrahi, neoplazm nüksü, lokal/cerrahi, radyoterapi, adjuvan/yan etki, rekonstrüktif cerrahi prosedürler/yöntem, cerrahi flep/yöntem/yan etki
The need for successive free flap applications for soft-tissue reconstruction in a case with recurrent oral carcinoma
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,
___
- Vikram B, Farr HW. Adjuvant radiation therapy in locally advanced head and neck cancer. CA Cancer J Clin 1983;33:134-8.
- Bhatia R, Bahadur S. Distant metastasis in malignancies of the head and neck. J Laryngol Otol 1987;101:925-8.
- P i c k f o rd MA, Soutar DS. Intraoral re c o n s t ru c t i o n using a second free flap for recurrent or metachronous carcinoma. Br J Plast Surg 1995;48:559-63.
- Demirkan F, Wei FC, Chen HC, Chen IH, Hau SP, Liau CT. Microsurgical reconstruction in recurrent oral can- cer: use of a second free flap in the same patient. Plast Reconstr Surg 1999;103:829-38.
- Demirkan F, Wei FC, Chen HC, Chen IH, Liao CT. O romandibular re c o n s t ruction using a third free flap in sequence in re c u r rent carcinoma. Br J Plast Surg 1999; 5 2 : 4 2 9 - 3 3 .
- Acartürk S, Akmanlar F, Dalay C. The free radial fore- arm flap for closure of large defects of upper lip and adjacent cheek tissue. Eur J Plast Surg 1989;12:60-5.
- Akın S, Özcan M, Kahveci R, fiafak E. Çeflitli defekt- lerin onarımında serbest skapular flep kullanımı. Türk Plastik Cerrahi Dergisi 1996;2:81-4.
- Aygenç E, Çelikkanat S, Karaca C, Özdem C. Mandi- buler rekonstrüksiyonda vasküler pediküllü kemik transferi. KBB-BBC Dergisi 2001;9:151-5.
- Suoglu Y, Erdamar B, Katircioglu S, Karatay C, Unal M. Oncologic and functional results in head and neck reconstruction with radial forearm free flaps. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 1999;6:206-11 .
- Schusterman MA, Kroll SS, Weber RS, Byers RM, Guillamondegui O, Goepfert H. Intraoral soft tissue reconstruction after cancer ablation: a comparison of the pectoralis major flap and the free radial forearm flap. Am J Surg 1991;162:397-9.
- K roll SS, Reece GP, Miller MJ, Schusterman MA. Comparison of the rectus abdominis free flap with the pectoralis major myocutaneous flap for reconstruc- tions in the head and neck. Am J Surg 1992;164:615-8.
- Boyd JB, Mulholland RS, Davidson J, Gullane PJ, Rotstein LE, Brown DH, et al. The free flap and plate in oromandibular reconstruction: long-term review and indications. Plast Reconstr Surg 1995;95:1018-28.
- Talesnik A, Markowitz B, Calcaterra T, Ahn C, Shaw W. Cost and outcome of osteocutaneous free-tissue transfer versus pedicled soft-tissue reconstruction for composite mandibular defects. Plast Reconstr Surg 1996;97:1167-78.
- Wei FC, Demirkan F, Chen HC, Chen IH, Liao CT, Hau SP. Management of secondary soft-tissue deficits fol- lowing microsurgical head and neck reconstruction by means of another free flap. Plast Reconstr Surg 1999; 103:1158-66.
- Shah JP, Haribhakti V, Loree TR, Sutaria P. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 1990; 160:352-5.
- Kroll SS, Goepfert H, Jones M, Guillamondegui O, Schusterman M. Analysis of complications in 168 pec- toralis major myocutaneous flaps used for head and neck reconstruction. Ann Plast Surg 1990;25:93-7.
- Wei FC, Demirkan F, Chen HC, Chen IH. Double free flaps in re c o n s t ruction of extensive composite mandibular defects in head and neck cancer. Plast Reconstr Surg 1999;103:39-47.
- Blackwell KE, Buchbinder D, Biller HF, Urken ML. Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps. Head Neck 1997;19:620-8.
- Chen HC, Demirkan F, Wei FC, Cheng SL, Cheng MH, Chen IH. Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in re c o n s t ruction of extensive composite mandibular defects. Plast Reconstr Surg 1999;103:839-45.
- Freeman JL, Walker EP, Wilson JS, Shaw HJ. The vas- cular anatomy of the pectoralis major myocutaneous flap. Br J Plast Surg 1981;34:3-10.
- O rd RA. The pectoralis major myocutaneous flap in oral and maxillofacial re c o n s t ruction: a re t rospective analysis of 50 cases. J Oral Maxillofac Surg 1996;54:1292-5.
- Wilson JS, Yiacoumettis AM, O’Neill T. Some observa- tions on 112 pectoralis major myocutaneous flaps. Am J Surg 1984;147:273-9.
- Saydam L, Özlüoğlu L, Taflel M, Çetin O. Majör bafl bo- yun defektlerinin onarımında pektoralis major myo- kütan flebi uygulamalarımız ve karflılafltığımız komp- likasyonlar. Türk ORL Arflivi 1992;30:52-5.
- Demirkan F, Chen HC, Wei FC, Chen HH, Jung SG, Hau SP, et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg 2000;53:30-6.
- ISSN: 2602-4837
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1991
- Yayıncı: İstanbul Üniversitesi
Sayıdaki Diğer Makaleler
Uğur ÇINAR, Özgür YİĞİT, Berna USLU COŞKUN, Ebru TOPUZ, Özlem ÜNSAL, Burhan DADAŞ, Birsen ÇETİN, Nuran ÖZCAN
Sinonazal lenfoma: Olgu sunumu
Sevilay AYDIN SÖNMEZ, Ferhat OĞUZ, Mehmet ADA, Burhan KOCAMAL
Larenks kanserlerinde DNA ploidinin prognostik önemi
Timur AKÇAM, Abdullah AKKAYA, Yalçın ÖZKAPTAN, Mustafa GEREK, Salih DEVECİ, Önder ÖNGÜRÜ
Kronik otit veya cerrahisi sonrasında oluşan dural kemik defektleri ve ensefalosel
Ahmet KIZILAY, İbrahim ALADAĞ, Yaşar ÇOKKESER, Orhan ÖZTURAN
Ferit DEMİRKAN, Emrah ARSLAN, Şakir ÜNAL, Alper AKSOY, Murat ÜNAL