Frontal flap repair for palate defect

Upper eyelid defect flap repair for surgical treatment of sputum cancer. Most of the squamous cell carcinomas are squamous cell carcinomas, and the adenocarcinomas are from small salivary glands, which are less common in hard sputum than soft sputum, but the latter is highly malignant. Carcinoma often invades the epiphysis, causing the upper eyelid to communicate with the nasal cavity. According to the principle of tumor surgery, those who have invaded the periosteum must also remove the epiphysis. Defects in sputum will affect language and swallowing, affecting patients' lives and socialization, and may cause physical and psychological obstacles. In the past, it was advocated that the tumor could be repaired after the tumor was cured, because premature repair would affect the observation of tumor recurrence. Recently, many scholars advocate early repair, because timely recovery of function is conducive to the improvement of patient quality of life, and the endoscopic examination of fiber can completely achieve the purpose of monitoring tumor recurrence after surgery. The hard palate defect can be repaired with a local tissue flap, a regional pedicle flap or a free flap; the soft palate is rich in muscle, and currently only the repair of the tissue defect volume can be achieved, and there is no ideal means for functional repair. The sputum is located at the top of the mouth and consists of hard palate and soft palate. 1. Hard palate: The skeleton that constitutes the hard palate has the temporomandibular process of the maxilla and the maxillary condyle and the horizontal plate of the humerus, collectively called the epiphysis, in which the front end of the line has incisors (nasal pupil), and there are nasal nerve vessels. The blood supply and sensation of the anterior iliac crest (between the canines on both sides) are provided. Each side of the epiphysis has a large hole in each of the lateral and external iliac vessels. Supply of blood and sensation at the back of the sputum (after the first premolar on both sides). The hard palate periosteum is very tightly connected to the mucous membrane on the surface and cannot be separated. It is called mucous membrane. It is tough and has a parotid gland. It is thick and easy to peel off from the bone surface, and it is rich in blood supply. The mucosa on the hard palate is thin and easy to tear. 2. Soft palate: It is the continuation of the hard palate to the back. It blocks the food from entering the nasal cavity. When the sound is pronounced, the air enters the nasal cavity, which is closely related to swallowing and speech. The soft palate is a curtain-shaped muscle structure with a mucous membrane covering the surface. The leading edge is the aponeurosis, attached to the posterior edge of the hard palate, the posterior edge is the free margin, the median of the free margin is the uvula, containing the same name muscle, both sides are the pharyngeal arch and the lingual arch, with the same name muscle. In addition, there are also squat levator muscles, snorkeling muscles, and joint management of soft palate movement (see "Cleft Palate Repair" for details). Treatment of diseases: pharyngeal insufficiency Indication Upper eyelid defect flap repair is applicable to: 1. Any defect in the ankle can be repaired with frontal flap, especially large defects or even full hard defects. 2. The superficial temporal artery and the frontal branch are intact. Contraindications 1. The forehead is too narrow and the area is not enough to repair the ankle defect. 2. Young patients, especially those who simply recover. 3. The pedicle superficial temporal artery or external carotid artery has been ligated, if the side has undergone a full neck dissection or a large dose of radiotherapy in the area. Preoperative preparation 1. Before the operation, the superficial temporal artery and frontal branch of the frontal pedicle should be diagnosed first. It is better to use ultrasound Doppler detection in order to trace the path of the blood vessel. 2. Measure the defect area and the area covered by the frontal flap and the length of the pedicle transfer. 3. Skin preparation for the donor site of the shaved head and frontal wound skin graft. Surgical procedure Ankle incision Fresh wounds, such as the jaw and the sputum removal, should leave the wound edge that can be sutured with the skin flap; if it is an old hole, it should be cut along the edge of the hole and peeled off to the periphery; if it is a soft and hard defect on one side, it should be cut at the same time. Open the soft side of the health side. According to the defect area, a flap is designed on the forehead to retain the length of the pedicle. Cut the forehead skin, subcutaneous and frontal muscles along the design, and separate the frontal flap along the periosteum. The upper iliac artery, the superior trochlear artery and the posterior branch of the superficial temporal artery (top branch) should be ligated during operation. Relaxation, such as designing a full-volume flap, it is best to have the pedicle including the posterior ear artery to increase the blood supply to the frontal valve. 2. Flap The frontal flap is peeled off from the periosteum, and the pedicle of the frontal sac is first cut along the middle incision, and the scalp is turned up along the shallow subcutaneous layer. The process should be very careful not to damage the shallowness of the skin under the skin. Arteries and their posterior branches. The deep part of the pedicle is then separated, ie it is turned up along the superficial fascia (Fig. 10.4.3.3.4-3). 3. Making a tunnel Separate the lower edge of the frontal incision of the frontal pedicle, cut off the superior iliac fascia of the zygomatic arch, and continue to separate downward to the deep intervertebral space of the zygomatic arch until the deep jaw of the condyle and the cheek groove. Throughout, fully blunt dissection, try to enlarge the gap, if necessary, separate the condyle from the oral side, cut off the diaphragm along the surface of the condyle, bite off the condyle, after the tunnel is completed, a long gauze can be introduced to suppress hemostasis. 4. The frontal flap is introduced into the mouth The free end of the frontal valve is sutured to the upper end of the tunnel indwelling gauze to fix a few needles, and the gauze is taken out from the oral side to introduce the frontal flap into the oral cavity. The frontal flap placed on the tunnel should be repaired to prevent the skin from being buried. Sebum retention and infection occur in the tissue. 5. Suture repair and defect If the defect is half-sided, the front end of the full flap can be partially folded, and the skin of the folded part is cut about 1 cm wide, so that the wound is close to the defect of the side wall of the defect, and the other edges of the flap are related to the defect of the ankle. The edge of the wound is relatively stitched. If the defect is full, the frontal valve is not enough length, and only a fault skin can be transplanted in the center of the frontal wound, and the edge of the frontal flap is sutured to the wound edge of the defect. 6. nasal cavity, oral pressure After the frontal valve repair, the iodoform gauze can be filled from the nasal cavity; the oral side can be wrapped with the long tail of the frontal flap to ensure the attachment of the skin and the elimination of the ineffective cavity between the folded frontal flaps. 7. Forehead wound skin grafting Generally, whole skin grafting can be used. In order to smooth the frontal skin grafting, 0.5cm of the skin graft edge can be used for a series of intermittent sutures, and the long line is used for wrapping and pressing. complication Infection Due to pollution or bleeding in the surgery area, hematoma is secondary to infection. 2. Skin flap necrosis The main reason is that the pedicle or the vascular pedicle is damaged during the operation due to the tunnel being too narrow or bleeding. 3. Forehead skin necrosis It is caused by excessive pressure of the package pressurization; it can also be because the skin is too thick and has subcutaneous fat. 4. Snoring Due to the small area of the frontal flap or the large local tension of the suture, part of the wound is split, or the tip of the frontal lobe is partially necrotic, resulting in a small penetration of the area.