臺灣博碩士論文加值系統

運用鎖骨上動脈島狀皮瓣重建頭頸部腫瘤手術後組織缺損，並探討其可行性。採
回溯性分析，蒐集2014年6月至12月間曾在義大醫院耳鼻喉部接受鎖骨上動脈島狀皮瓣以重建頭頸部組織缺損的病患為研究對象，整理分析其臨床資料，包括：性別、年齡、腫瘤部位及缺損部位、皮瓣大小、淋巴廓清與否、放射治療與否、皮瓣存活率及術後之皮瓣相關併發症。
共12位病人：11位男性，1 為女性；年齡分佈為45歲至73歲，平均55歲；其中8位為下咽癌病患，2位為口腔癌病患，1位為喉癌病患，1位為深頸部感染病患。8位下咽癌病患中，其中6位接受部分咽喉切除手術，2位接受全咽喉切除手術。皮瓣平均大小為6.5公分寬，11公分長。12位病患，術後追蹤至今，全部病患的鎖骨上動脈島狀皮瓣均存活。3位下咽癌病患則發生皮瓣邊緣處部分壞死，須以胸大肌皮瓣或胃上拉(gastric pull up)的方式進行救援手術。一位口腔癌病患則因頸部皮瓣隧道處有滲漏而影響皮瓣供皮區的癒合，曾接受供皮區清創手術。
鎖骨上動脈島狀皮瓣在頭頸部腫瘤手術的重建上，提供了另一理想的選擇；然而，對於需廣泛淋巴廓清及頸部接受過放射治療之病患，由於可能會傷及橫頸動脈的血液供應，此一皮瓣的引用，應謹慎選擇。

BACKGROUND: The supraclavicular artery island flap, an alternative to traditional regional or free flap, is gradually successfully used in head and neck reconstruction of various kinds of head and neck defects.

METHODS: From June 2014 to December 2014, 12 patients who underwent head and neck surgery with the supraclavicular artery island flap reconstruction at E-Da hospital were enrolled in this study. The demographic data, clinical presentation, flap design, complication as well as functional outcome of each patient were retrospectively collected and analyzed.

RESULTS: These 12 patients (11 men and 1 women), aged 45-73 years, underwent supraclavicular artery island flap reconstruction immediately following the head and neck tumor resection. The surgical defects included pharynx (8), oral cavity (1), tracheal-stoma (1), and neck or face (2). The dimension of the flap was averagely 6.5cm x 11cm. The overall flap survival rate was 100%. 3 patients experienced partial skin loss and were rescued by the pectoralis major myocutaneous flap or gastric pull-up surgery. 1 patient experienced the donor site minor wound dehiscence and received further debridement.

CONCLUSIONS：The supraclavicular artery island flap is a reliable alternative in head and neck reconstruction. Neck dissection (level IV or V) or radiation history can compromise the blood supply of the supraclavicular island flap and may impede the choice of this flap.

中文摘要 ………………………………………………………………3
英文摘要 ………………………………………………………………4
誌謝……………………………………………………………………5第一章 前言…………………………………………………………6第二章 材料與方法
解剖構造……………………………………………………7
手術技巧………………………………………………………8
第三章 結果
病例一 深頸部感染併後頸部皮膚缺損…………………12
病例二 舌癌手術缺損之口腔重建………………………13
病例三 下咽癌經部分咽喉切除後咽壁缺損重建………14
病例四 下咽癌經全咽喉切除後全咽壁缺損重建………16
病例五 喉癌經全喉切除後前頸部及氣切造口重建……18
第四章 討論
併發症………………………………………………………21
研究限制……………………………………………………23
第五章 結論
參考文獻………………………………………………………………25
附表……………………………………………………………………26

1.Lamberty BG: The supraclavicular axial patterned flap. Br J Plast Surg 1979, 32: 207-212.
2.Khouri RK, Ozbek MR, Hruza GJ, Young VL: Facial reconstruction with prefabricated induced expanded supraclavicular skin flaps. Plast Reconstr Surg 1995; 1007-1015.
3.Mizerny Br, Lessard ML, Black MJ: Transverse cervical artery fasciocutaneous free flap for head and neck reconstruction: initial anatomic and dye studies. Otolaryngol Head Neck Surg 1995; 113:564-568.
4.Pallua N, Machens HG: The asciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures. Plast Reconstr Surg 1997; 99: 1878-1884.
5.Abe M, Murakami G, Abe S, Sakakura Y, Yajima T: Supraclavicular artery in Japanese: an anatomical basis for the flap using a pedicle containing a cervical, non-perforating cutaneous branch of the superficial cervical artery. Okajimas Folia Anat Jpn 2000; 77: 149-54.
6.Pallua N, von Heimburg D: Pre-expanded ultra-thin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery. Plast Reconstr Surg 2005; 115: 1837-1844.
7.Vinh VQ, Van Anh T, Ogawa R, Hyakusoku H: Anatomical and clinical studies of the supraclavicular flap. Plast Reconstr Surg 2009; 123: 1471-1480. doi: 10.1097/PRS.0b013e3181a205ba.
8.Tayfur V, Magden O, Edizer M, Menderes A: Supraclavicular artery flap. J Craniofac Surg 2010; 21(6): 1938-1940. doi: 10.1097/SCS.0b013e3181f4ee38.
9.Pallua N, Magnus Noah E: The tunneled supraclavicular island flap. Plast Reconstr Surg 2000; 105: 842-851.
10.Seidenberg B, Rosenak SS, Hurwitt ES, Som ML: Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 1959; 149: 162–171.
11.Liu R, Gullane P, Brown D, Irish J: Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol 2001; 30:34-40.
12.Kokot N, Mazhar K, Reder LS, Peng GL, Sinha UK: Use of the supraclavicular artery island flap for reconstruction of cervicofacial defects. Otolaryngol Head Neck Surg 2014; 150: 222–228. doi: 10.1177/0194599813514205.
13.Emerick KS, Herr MA, Deschler DG: Supraclavicular flap reconstruction & following total laryngectomy. Laryngoscope 2014; 124: 1777–1782. doi: 10.1002/lary.24530.
14.Emerick KS, Herr MW, Lin DT, Santos F, Deschler DG: Supraclavicular artery island flap for reconstruction of complex parotidectomy, lateral skull base, and total auriculectomy defects. JAMA Otolaryngol Head Neck Surg 2014; 140:861-866. doi: 10.1001/jamaoto.2014.1394.
15.Giovanni Di Benedetto, Angelica Aquinati, Marina Pierangeli, Alessandro Scalise, Aldo Bertani: From the “Charretera” to the Supraclavicular Fascial Island Flap: Revisitation and Further Evolution of a Controversial Flap. Plastic & Reconstructive Surgery 2005; 115:70-76.
16.Kokot N, Mazhar K, Reder LS, Peng GL, Sinha UK: The supraclavicular artery island flap in head and neck reconstruction: applications and limitations. JAMA Otolaryngol Head Neck Surg 2013; 139:1247–1255. doi: 10.1001/jamaoto.2013.5057.
17. Granzow JW, Suliman A, Roostaeian J, Perry A, Boyd JB: The supraclavicular artery island flap (SCAIF) for head and neck reconstruction: surgical technique and refinements. Otolaryngol Head Neck Surg 2013; 148:933–940. doi: 10.1177/0194599813484288.
18.Sandu K, Monnier P, Pasche P: Supraclavicular flap in head and neck reconstruction: experience in 50 consecutive patients. Eur Arch Otolaryngol 2012; 269:1261-1267. doi: 10.1007/s00405-011-1754-0.
19.Chiu ES, Liu PH, Friedlander PL: Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg 2009; 124:115-123. doi: 10.1097/PRS.0b013e3181aa0e5d.
20.Herr MW, Bonanno A, Montalbano LA, Deschler DG, Emerick KS: Shoulder function following reconstruction with the supraclavicular artery island flap. Laryngoscope 2014; 124:2478-2483. doi: 10.1002/lary.24761.
21.Alves HR, Ishida LC, Ishida LH, et al: A clinical experience of the supracla- vicular flap used to reconstruct head and neck defects in late-stage cancer patients. J Plast Reconstr Aesthet Surg 2012; 65:1350–1356. doi: 10.1016/j.bjps.2012.04.050.
22.Herr MW, Emerick KS, Deschler DG: The supraclavicular artery flap for head and neck reconstruction. JAMA Facial Plast Surg 2014; 16:127–132.
doi: 10.1001/jamafacial.2013.2170.


23.Adams As, Wright MJ, Johnston S, et al: The use of multislice CT angiography preoperative study for supraclavicular artery island flap harvesting. Ann Plast Surg 2012; 69:312-315. doi: 10.1097/SAP.0b013e31822afaba.