Recently, the head and neck surgery department of Hunan Cancer Hospital successfully performed a radical operation and repair for a patient with left buccal and right tongue cancer through bilateral anterolateral thigh flaps transplantation using 3D printing and preoperative CTA vascular reconstruction techniques.
Two cancers were detected in men's oral cavity
Mr. Yang, a 49-year-old patient, found a mass in the left oral cavity six months ago, which gradually increased and invaded the local skin. At the local hospital, a new organism was found on the right side of the tongue, which was confirmed by biopsy as 'squamous cell carcinoma'. The doctor told us that it was cancer and the treatment was difficult. The patient's family was like a bolt from the blue. After many inquiries, the patient came to the second Department of head and neck surgery of the provincial cancer hospital for hospitalization.
After carefully examining the cases and related examinations, the chief physician Yu Jianjun formulated a detailed surgical plan for the department. According to the plan, three flaps are needed to repair the defect after left buccal perforation and right tongue resection. Bilateral anterolateral thigh flap (ALT) is recommended to repair the defect.
Therefore, it is particularly important to accurately assess the extent of primary lesion excision, the location of perforator flaps and the donor area before operation. Director Yu suggested that the combination of 3D printing technology and CTA vascular reconstruction technology provide technical support for accurate surgery.
Successful completion of resection and repair in 13 hours
Members of the surgical team of the deputy chief physician of Tian Ji of the Department immediately made preparations for division of labor: after obtaining satisfactory imaging data with the support of the radiology department, they exchanged and discussed repeatedly with the technical staff of the 3D printing company, outlined the location of the tumors in software and expanded the scope of resection according to the principles of operation; after reconstruction of CTA vessels of bilateral lower extremities To mark the perforator, select the donor side, accurately design the position, size and direction of the flap, and communicate with the anesthesia department to improve the preparation.
Finally, on May 24, 2016, under the guidance of Director Yu, Tian Zhi, deputy director of the surgeon's knife operation team, lasted more than 13 hours, and successfully performed the operation for patients. After the operation, the patients were discharged smoothly after careful care by medical staff, and the rehabilitation effect was satisfactory.
3D printing escorts precise surgery
Director Yu Jianjun introduced that this is a case of oral double cancer, the condition is complex, clinical rare. Especially, the lesions are located on the left and right sides, and the defect area of the cheek is large, so it is difficult to use only three flaps from a set of vascular pedicles for repair. Bilateral ALT needs to be prepared. However, the patient's leg muscles are well developed, once the skin is removed too much, it will lead to the donor area of the leg can not be closed and sutured, and increase the greater trauma. Therefore, bilateral neck dissection, left cheek perforation resection, right tongue resection and bilateral free anterolateral thigh flap repair were selected for the patients.
The use of 3D technology not only reduces the tumors, but also prints the enlarged resected parts together by simulation technology, which makes the radical operation more reasonable and accurate. At the same time, experts use CTA and three-dimensional reconstruction technology to identify the perforator vessels of both lower limbs, combined with the size and direction of the defect on the oral and maxillofacial 3D printing model. Precise and individualized skin flaps were designed before the operation to ensure the smooth implementation of the operation. At the same time, the wounds in the donor site were reduced to a great extent and satisfactory results were obtained.