ろっ骨付遊離筋皮弁を用いた下がく即時再建手術の１例

Abstract

A case of one-stage serratus anterior osteomyoctaneous free flap was reported. The patient was a 42-year-old male. He had 45×35 mm primary cancer lesion in the middle of the mandible. However the X-ray films at first visit (9-2-1981) showed no abnormal figure. He was clinically diagnosed as mandible cancer (T3 NO MO), He had taken radiotherapy of Linac 4, 000 rads and Au-grain mold 6, 600 rads from September 17th to November 30th. After 5 months, radio-osteonecrosis of mandible was observed in the region of 6+6. He had complained of severe pain, especially contact pain, of the mandible for 10 months. Metastasis of cancer did not occur in the cervical lymph nodes. Then we deceided to operate on the mandibular radio-osteonecrosis. We used a free osteomyocutaneous flap from the chest to replace a loss of the mandible and the mouth floor. The mandible was resected continuously at the 7+7 portion, and the mouth floor was resected partially. For closure of the defect, the serratus anterior flap with the 6th rib was turned into the mouth. The flap was then revascularized by anastomosing the nutrient thoracodorsal vessels to the facial vessels. Then the flap was well revascularized and its color and texture became significantly better after 6 months. As absorption of the transferred bone was minimal, we made a denture. The prognosis is now satisfactory.