頭頸部癌の再建外科・術式及び成績

Various surgery techniques performed on 26 advanced cancer patients using forehead, deltopectoral(D-P) and musculocutaneous(M-C) flaps were reviwed. The D-P flap presents few cosmetic problems in the head and neck region and can be used in elder patients because of little operative invasion. The M-C flap allows for reconstruction of defects in a one-stage operation which may shorten hospitalization and permit an ealier return to social life. The forehead flap is the most durable and reliable flap among them for reconstructive surgery, though it offers some cosmetic problems. In reconstruction of the esophagus after a pharyngolaryngoesophagectomy for cancer of the hypopharynx and the cervical esophagus, it seems more advantageous to use a hige flap in reconstruction than Bakamjian's original method since early detection of a local recurrence of the tumor is rendered easier with the former. There were no fatal postoperative complication, though minor necrosis, fistula, suture insufficiency and esophageal stenosis were observed, but improved with conservative treatment. Conseqently, the reliability and versatility of pedicle and muculocutaneous flaps were confirmed. As to the prognosis, the 2-year survival rate was 42.2% . The cause of death was local recurrence in 4 patients, who all died within two years, and distant metastasis in 4 patients, who all died within one year of the operation. Local recurrence and distant metastasis were also seen in 4 patients who survived.