Development of functional reconstructive surgery based on QOL evaluation

DOI
  • Sarukawa Shunji
    Department of Plastic Surgery, Jichi Medical University
  • Ohyatsu Yukio
    Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University
  • Noguchi Tadahide
    Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University
  • Nishino Hiroshi
    Department of Otolaryngology, Head and Neck Surgery, Jichi Medical University
  • Sugawara Yasushi
    Department of Plastic Surgery, Jichi Medical University

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Other Title
  • QOL調査に基づいた機能再建の治療戦略
  • Sternocleidomastoideus dynamic reconstruction using the rectus abdominis muscular flap (Original Article)
  • ―腹直筋移植による胸鎖乳突筋動的再建―（原著）

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Abstract

Results of a preliminary study, in which the University of Washington Quality of Life Scale (UW-QOL) was used for 26 patients who had undergone immediate reconstruction with free flap against oral cancer, were evaluated and showed 4 important domains for better QOL; swallowing, speech, shoulder, and taste. Additionally, a more focused study on the shoulder domain among 41 patients showed that resection of the sternocleidomastoid muscle (SCM) is a negative factor. Based on the results of these 2 studies, we performed SCM dynamic reconstructive surgery on 6 patients whose SCM was resected through neck dissection.<br>For the graft we used the free rectus abdominis musculocutaneous flap. The primary sites of the patient were the tongue (5 patients) and buccal mucosa (1 patient), and all patients underwent postoperative radiotherapy. The muscular flap was fixed with both stumps of the SCM with enough longitudinal tension, and one costal nerve selected through confirmation of the muscle excursion with the nerve stimulator was anastomosed to the stump of the accessory nerve. Regrettably, the results for the shoulder domain in UW-QOL for these 6 cases have not improved after 6 months postoperatively. We consider the causes to be that the muscle graft did not work enough or that the SCM itself is not a truly important factor for shoulder functions.

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