OUR CONCEPT FOR LOW-INVASIVE RECONSTRUCTION IN THE HEAD AND NECK

頭頸部再建の目指すところは, 創傷治癒が遷延することなく, 摂食・会話などの術後機能をできるだけ維持することにあるが, 患者の負担軽減も重要な課題である。この目的で, われわれは以下の点において工夫している。1) 手術時間の短縮と出血量の減少を目指す目的で, 腫瘍の切除と同時に挙上が可能な皮弁を第一選択としている。2) 皮弁採取部の犠牲を少なくする目的で腹直筋皮弁, 前外側大腿皮弁では筋体採取量を必要最小限にとどめている。3) 術後の呼吸器やせん妄などの全身合併症を防ぐため早期の離床を図っている。4) 主要血管への感染予防のため, 局所の膿瘍などの合併症を早期に発見するよう努めている。これらの工夫において得られた結果を当施設で行っている入院治療の流れとともに報告した。

[1]  T. Nakatsuka,et al.  Evaluating the donor site after harvest of free jejunum grafts , 2002, Head and Neck.

[2]  O. Yuge,,et al.  [Patient-controlled epidural analgesia with bupivacaine and fentanyl suppresses postoperative delirium following hepatectomy]. , 2001, Masui. The Japanese journal of anesthesiology.

[3]  T. Nakatsuka,et al.  Anterolateral thigh flap donor-site complications and morbidity. , 2000 .

[4]  P. Cordeiro,et al.  Factors associated with complications in microvascular reconstruction of head and neck defects. , 1999, Plastic and reconstructive surgery.

[5]  T. Nakatsuka,et al.  Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. , 1997, Archives of otolaryngology--head & neck surgery.

[6]  T. McCulloch,et al.  Risk factors for pulmonary complications in the postoperative head and neck surgery patient , 1997, Head & neck.

[7]  A. Batchelor,et al.  Microvascular Free‐Tissue Transfers in Elderly Patients: The Leeds Experience , 1996, Plastic and reconstructive surgery.

[8]  D. Schuller,et al.  Preoperative identification of patients at risk for delirium after major head and neck cancer surgery , 1995, The Laryngoscope.

[9]  K. Harii.  A comparative evaluation of the free forearm flap and intestinal transplantation in reconstruction of the hypopharynx and cervical esophagus , 1991 .

[10]  H. Goepfert,et al.  Analysis of Complications in 168 Pectoralis Major Myocutaneous Flaps Used for Head and Neck Reconstruction , 1990, Annals of plastic surgery.

[11]  J. Conley,et al.  Platysma myocutaneous flap revisited. , 1986, Archives of otolaryngology--head & neck surgery.

[12]  S. Ariyan.  The Pectoralis Major Myocutaneous Flap A Versatile Flap for Reconstruction in the Head and Neck , 1979, Plastic and reconstructive surgery.

[13]  J. Howard,et al.  Studies of paralytic lleus , 1975 .

[14]  V. Bakamjian.  A TWO-STAGE METHOD FOR PHARYNGOESOPHAGEAL RECONSTRUCTION WITH A PRIMARY PECTORAL SKIN FLAP. , 1965 .

[15]  光嶋勲.  Perforator-based flap(穿通動脈皮弁)-より犠牲の少ない皮弁を求めて- , 1996 .

[16]  J. Gluckman,et al.  Complications associated with free jejunal graft reconstruction of the pharyngoesophagus--a multiinstitutional experience with 52 cases. , 1985, Head & neck surgery.