肩甲下動静脈系複合皮弁を用いた上顎・下顎再建

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  • Our experiences of maxillary and mandibular reconstruction with subscapular system composite flaps.

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Recent advances in plastic & reconstructive surgery have dramatically improved the result of head and neck reconstruction. In order to meet the growing need for the three-dimensional, anatomical reconstruction, a reliable flap with multiple skin paddles and multiple bone segments has been searched for. We believe that the subscapular system composite flap is best suited for this purpose. The latissimus dorsi (LD) mc flap and scapular flap can be used as a main flap. The lateral border and inferior angle of the scapula can be elevated as one or separate bone flaps. We have also developed pedicled rib bone flaps vascularized with perforating branchs of the 8th-11th posterior intercostal arteries which can be attatched to the LD mc flap. It should be atressed that all these bone flaps are well vascularlized and can be arbitrarily and three-dimensionally positioned. The LD muscle can be splitted and used for dynamic reconstruction (smile restoration). Thus with the only one pair of long and reliable vessels a versatile and “multifunction” flap can be elevated and tailored to fit each patient's unique defects. We also found that the angular branch is better used with the LD mc flap than with the scapular flap because it gives longer pedicle.<br>Thirteen maxillary reconstruction and 9 mandibular reconstruction was done with good and predictable result and with very low rate of complication. Our operative technique and representative case is shown.

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  • 頭頸部腫瘍

    頭頸部腫瘍 20 (3), 446-452, 1994

    日本頭頸部癌学会

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