ISSN: 1300 - 6525 E-ISSN: 2149 - 0880
kulak burun boğaz
ve baş boyun cerrahisi dergisi
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ORIGINAL RESEARCH

Reconstruction of Oral Cavity Defects with Free Flaps After Ablation of Intraoral Cancers
Ağız İçi Kanserlerin Eksizyonu Sonrasında Gelişen Defektlerin Serbest Fleplerle Rekonstrüksiyonu
Received Date : 06 Sep 2020
Accepted Date : 10 Nov 2020
Available Online : 11 Feb 2020
Doi: 10.24179/kbbbbc.2020-78817 - Makale Dili: TR
KBB ve BBC Dergisi. 2021;29(1):50-7
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: Our aim in this study is to retrospectively examine the results of free flaps used in the closure of intraoral defects developed after oncologic surgery and to share our experiences. Material and Methods: Between 2015 and 2020, Başkent University Plastic, Reconstructive and Aesthetic Surgery Department retrospectively screened 13 patients with intraoral defects who developed intraoral defects after a total of oncological resection. Tumor resections and neck dissections of all patients were performed by Başkent University Ear, Nose and Throat Diseases Department. Immediate reconstruction of intraoral defects were performed by Başkent University Department of Plastic, Reconstructive and Aesthetic Surgery. Results: 9 of the patients were male and 4 were female. The average age was 54.3 (22-84). The localization of the defects were at the floor of the mouth in 9 patients and the roof of the oral cavity in 4 patients. The sizes of the defects were between 5x4 cm and 17x14 cm. 6 patients underwent ipsilateral radical neck dissection in addition to tumor resection. Free radial forearm flap was applied in 7 patients, latissimus dorsi muscle skin flap in 4 patients, free fibula flap in 2 patients. Of the 6 patients with mandibular defects accompanying the floor of the mouth, 2 were reconstructed with free fibular flaps, and 4 patients were reconstructed with a 2.4 mm profiled titanium reconstruction plate. No flap lost was seen. Average follow-up time was 434 days (90-1,700). Conclusion: Free flaps can provide sufficient amount of tissue in a single session for repairing defects in the floor and roof of the oral cavity after oncological surgery. For success in surgery, a good planning with a multi-disciplinary approach in the preoperative period, careful follow-up and care in the post-operative period are required.
ÖZET
Amaç: Bu çalışmadaki amacımız, onkolojik cerrahi sonrasında gelişmiş ağız içi defektlerin kapatılmasında kullandığımız serbest fleplerin sonuçlarını retrospektif olarak incelemek ve tecrübelerimizi paylaşmaktır. Gereç ve Yöntemler: Başkent Üniversitesi Plastik, Rekonstrüktif ve Estetik Cerrahi Bölümünde 2015-2020 yılları arasında, onkolojik rezeksiyon sonrası ağız içi defekti gelişmiş ve serbest fleplerle onarım yapılmış 13 hasta, retrospektif olarak tarandı. Tüm hastaların tümör eksizyonları ve boyun diseksiyonları, Başkent Üniversitesi Kulak Burun Boğaz Hastalıkları tarafından yapılırken, rekonstrüksiyonları ameliyata dâhil olunarak, Başkent Üniversitesi Plastik, Rekonstrüktif ve Estetik Cerrahi Bölümü tarafından aynı seansta gerçekleştirilmiştir. Bulgular: Hastaların 9’u erkek, 4’ü kadındı. Yaş ortalaması 54,3 (22-84) idi. Defektlerin lokalizasyonu, 9 hastada ağız tabanı, 4 hastada ağız tavanındaydı. Defektlerin boyutları, 5x4 cm ile 17x14 cm arasındaydı. 6 hastaya tümör eksizyonuyla beraber ipsilateral radikal boyun diseksiyonu yapıldı. 7 hastaya serbest radyal ön kol flebi, 4 hastaya latissimus dorsi kas deri flebi, 2 hastaya serbest fibula flebi uygulandı. Ağız tabanına eşlik eden, mandibula defekti olan 6 hastadan 2’sine serbest fibula flebi, 4 hastaya ise 2,4 mm profilli titanyum rekonstrüksiyon plağı ile mandibula rekonstrüksiyonu yapıldı. Hiçbir flep kaybedilmedi. Ortalama takip süresi, 434 gün (90-1.700) idi. Sonuç: Ağız tabanı ve tavanında, onkolojik cerrahi sonrasında gelişen defektlerin onarılmasında serbest flepler yeterli miktarda dokuyu tek seansta temin edebilmektedir. Cerrahide başarı için preoperatif dönemde multidisipliner yaklaşımla iyi bir planlama ve postoperatif dönemde özenli takip ve bakım gereklidir.
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