구강악안면 영역의 재건을 위한 대흉근피판의 임상적 평가
Evaluation of the Pectoralis Major Myocutaneous Flap for Oral and Maxillofacial Reconstructive Surgery
나광명, 김진욱, 이호진, 권태건, 이상한, 김진수,
소속 상세정보
나광명 ( Na Kwang-Myung ) - 경북대학교 치의학전문대학원 구강악안면외과학교실
김진욱 ( Kim Jin-Wook ) - 경북대학교 치의학전문대학원 구강악안면외과학교실
이호진 ( Lee Ho-Jin ) - 경북대학교 치의학전문대학원 구강악안면외과학교실
권태건 ( Kwon Tae-Geon ) - 경북대학교 치의학전문대학원 구강악안면외과학교실
이상한 ( Lee Sang-Han ) - 경북대학교 치의학전문대학원 구강악안면외과학교실
김진수 ( Kim Chin-Soo ) - 경북대학교 치의학전문대학원 구강악안면외과학교실
KMID : 1036320130350050277
Abstract
Purpose: Well vascularized pectoralis major myocutaneous flap (PMMF) had been a commonly used versatile flap in reconstructive oromaxillofacial surgery since the 1970s. However, after the advent of microvascular surgery in the 1980s, the PMMF was used less frequently. But, to date, PMMF has been useful and has some advantages such as covering wide defects, covering vital structures, back-up procedure in cases of free flap failure, and reconstruction for radiotherapy patients. The purpose of this study is to evaluate the role, indication, complications, functional, and aesthetic results of this flap in the era of free flap with a literature and chart review.
Methods: A retrospective study was conducted of 16 oral cancer patients undergoing reconstructive surgery with PMMF for reconstruction of defects from 2001 to 2012 at Kyungpook National University Hospital. The male to female ratio was 10:6, with a mean age of 63 years (16~79 years). Basic demographic data, previous treatment history, indications, dimension of the flap, site of reconstruction, postoperative complications, and patients’ final status were systemically analyzed from chart review.
Results: The pathology of the disease included squamous cell carcinoma in the majority of cases (n=14). The remaining cases were fibrosarcoma and mucoepidermoid carcinoma. Of the 16 PMMF reconstructions, 13 flaps were applied as primary reconstructive procedures, whereas three flaps were; salvage; procedures (vascularized free flap failure). Twelve patients had complications such as wound dehiscence, infection, hematoma, fistula, flap bulkiness, and partial flap necrosis. The higher complication rates showed an association with utilization of the flap in preoperative radiotherapy cases. However, all patients were discharged without failure.
Conclusion: In reconstructive oromaxillofacial surgery, the PMMF is still a useful flap for huge defects. In addition, the PMMF can be used as a salvage procedure after vascularized free flap failure and reconstruction for patients with a history of preoperative radiotherapy.
키워드
Oral and maxillofacial reconstructive surgery;Pectoralis major myocutaneous flap;Salvage operation
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