인두피부누공의 치료을 위한 요골전환유리피판의 새로운 도판

Abstract

Pharyngocutaneous fistula is a dreaded complication of ablative surgery of the aerodigestive tract such as pharynx and larynx. This is a common problem for the surgeon. We present two patients with glottic carcinoma who suffered from pharyngocutaneous fistulae which developed after total laryngectomy and radiation therapy. The fistulae were reconstructed with newly designed radial forearm free flaps. A radial forearm free flap larger than the defect was elevated and the flap, except the central inner lining area, was deepithelized. Skin around the defect was removed and then deepithelized. The inner lining was made with the central skin paddle. The deepithelized area was placed over the deskinned area around the defect. The final outer covering of skin graft was extended to the surrounding deepithelized areas. We obtained a obliteration of the fistulae and natural neck contour using this method. This new design has the following advantages; large contact area between the flap and the inflammed surrounding tissue, discontinuity between the suture lines of the inner lining and the outer covering, and reinforcement of suture line of outer covering with skin graft. We believe that this is a useful method for reconstructing irradiated pharyngocutaneous fistulae.