پديد آورندگان :
ﻓﺎﻃﻤﯽ، ﻣﺤﻤﺪﺟﻮاد دانشگاه علوم پزشكي ايران - بيمارستان حضرت فاطمه - مركز تحقيقات سوختگي - گروه جراحي ترميمي و پلاستيك , ﮐﺎﻇﻤﯽ آﺷﺘﯿﺎﻧﯽ، ﻋﺒﺎس دانشگاه علوم پزشكي ايران - بيمارستان حضرت فاطمه - گروه جراحي ترميمي و پلاستيك , ﻧﯿﺎزي، ﻣﯿﺘﺮا دانشگاه علوم پزشكي ايران - مركز تحقيقات سوختگي
چكيده فارسي :
زﻣﯿﻨﻪ و ﻫﺪف: ﺷﮑﺎف ﮐﺎم )Cleft Palate( ﺷﺎﯾﻌﺘﺮﯾﻦ ﻧﺎﻫﻨﺠﺎري ﻣﺎدرزادي ﮐﺮاﻧﯿﻮﻓﺎﺷﯿﺎل ﺑﻮده و ﺗﻘﺮﯾﺒﺎً ﯾﮏ ﻣﻮرد در ﻫﺮ 2000 ﺗﻮﻟﺪ زﻧﺪه اﺗﻔﺎق ﻣﯽاﻓﺘﺪ. در اﻏﻠﺐ اﯾﻦ ﺑﯿﻤﺎران از ﺑﺎﻓﺖﻫﺎي ﻣﻮﺿﻌﯽ و ﻣﻨﻄﻘﻪاي داﺧﻞ دﻫﺎن ﺑﺮاي ﺗﺮﻣﯿﻢ آن اﺳﺘﻔﺎده ﻣﯽﺷﻮد. ﺑﺎ اﯾﻦ
ﻫﻤﻪ در ﻣﻮارد ﺷﮑﺎف وﺳﯿﻊ ﯾﺎ ﻓﯿﺴﺘﻮلﻫﺎي ﺑﺰرگ و ﯾﺎ ﻋﻮد ﮐﺮده، اﯾﻦ روشﻫﺎ ﮐﺎﻓﯽ ﻧﺒﻮده و ﻧﯿﺎز ﺑﻪ اﻧﺘﻘﺎل ﻓﻠﭗﻫﺎي آزاد اﺳﺖ.
ﻣﻮاد و روش ﻫﺎ: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﮔﺬﺷﺘﻪ ﻧﮕﺮ در ﺑﯿﻤﺎرﺳﺘﺎن ﺣﻀﺮت ﻓﺎﻃﻤﻪ)س( ﭘﺮوﻧﺪه ﻫﻔﺪه ﺑﯿﻤﺎر ﺑﺎ ﺷﮑﺎف ﯾﺎ ﻓﯿﺴﺘﻮل ﮐﺎم ﮐﻪ ﺑﺎ ﻓﻠﭗ آزاد درﻣﺎن ﺷﺪه ﺑﻮدﻧﺪ، ﺑﺮرﺳﯽ ﺷﺪ. اﻃﻼﻋﺎت ﺷﺎﻣﻞ ﺳﻦ، ﺟﻨﺲ، ﻋﻠﺖ ﻋﻤﻞ ﺟﺮاﺣﯽ، ﻧﻮع ﻓﻠﭗ ﻣﻨﺘﻘﻞ ﺷﺪه، ﺷﺮﯾﺎن و ورﯾﺪ ﮔﯿﺮﻧﺪه آﻧﺎﺳﺘﻮﻣﻮز، وﺳﻌﺖ ﻓﻠﭗ ﻣﻨﺘﻘﻞ ﺷﺪه، ﻧﻮع اﻧﺘﻘﺎل از ﻧﻈﺮ ﭘﺮي ﻻﻣﯿﻨﯿﺖ ﯾﺎ ﺑﺎ ﮔﺮاﻓﺖ، ﻧﺘﯿﺠﻪ اوﻟﯿﻪ، ﻋﻮارض دراز ﻣﺪت، ﺗﺄﺛﯿﺮ روي ورود ﻣﻮاد ﻏﺬاﯾﯽ ﺑﻪ ﺑﯿﻨﯽ و ﻣﺸﮑﻼت ﺗﮑﻠﻢ ﺟﻤﻊ آوري ﺷﺪﻧﺪ. دادهﻫﺎ ﺑﺎ ﻧﺮم اﻓﺰار SPSS وﯾﺮاﯾﺶ 19 ﻣﻮرد ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﻗﺮار
ﮔﺮﻓﺘﻨﺪ و ﺑـﺎ اﺳﺘﻔﺎده از آﻣﺎر ﺗﻮﺻﯿﻔﯽ آﻧﺎﻟﯿﺰ ﺷﺪﻧﺪ.
ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ ﺳﻨﯽ ﺑﯿﻤﺎران 13/540± 15/705 )3 -54 ﺳﺎل( ﺑﻮد. 10 ﻧﻔﺮ )60%( از ﺑﯿﻤﺎران ﻣـﺮد و 7 ﻧﻔـﺮ )40%( زن ﺑﻮدﻧﺪ. 8 ﺑﯿﻤﺎر )47%( ﺑﻪ ﻋﻠﺖ ﺷﮑﺎف ﮐﺎم وﺳﯿﻊ ])Wide Cleft Palate (WCP[، 7 ﻧﻔﺮ )41%( از ﺑﯿﻤﺎران ﺑﻪ ﻋﻠﺖ ﻓﯿﺴﺘﻮل ﮐﺎم ﻋـﻮد ﮐﺮده ])Palatal Fistula (PF[ و ﯾﮏ ﻧﻔﺮ )6%( از ﺑﯿﻤﺎران ﺑﻪ ﻋﻠﺖ ﻧﻘﺺ وﺳﯿﻊ ﮐﺎم ﻧﺎﺷﯽ از رزﮐﺴﯿﻮن ﺗﻮﻣﻮر و ﯾﮏ ﻧﻔﺮ )6%( ﺑﻪ ﻋﻠﺖ ﻧﻘﺺ وﺳﯿﻊ ﮐﺎم ﺑﻪ دﻧﺒﺎل ﻋﻔﻮﻧﺖ ﻗﺎرﭼﯽ ﻣﻮﮐﻮرﻣﺎﯾﮑﻮﺳﯿﺲ ﺑﺎ ﺑﯿﻤﺎري زﻣﯿﻨﻪاي دﯾﺎﺑﺖ ﮐﺎﻧﺪﯾﺪ اﻧﺘﻘﺎل ﻓﻠﭗ آزاد ﺷﺪﻧﺪ. ﻫﻤﻪ ﻓﻠﭗﻫﺎ زﻧﺪه ﻣﺎﻧﺪﻧﺪ و ﻧﮑﺮوز ﮐﺎﻣﻞ ﯾﺎ ﭘﺎرﺷﯿﻞ ﻓﻠﭗ دﯾﺪه ﻧﺸﺪ. ورود ﻏﺬا ﺑﻪ ﺑﯿﻨﯽ Nasal Regurgitation در ﻫﻤﻪ ﺑﯿﻤﺎران ﺑﻪ ﺟﺰ ﺳﻪ ﻧﻔﺮ درﻣﺎن ﺷﺪ و
ﮐﯿﻔﯿﺖ ﺗﮑﻠﻢ ])Velopharyngeal Insufficiency (VFI[ ﺑﻬﺒﻮدي ﻧﺸﺎن داد.
ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﻓﻠﭗ رادﯾﺎل ﺳﺎﻋﺪ ﯾﮑﯽ از ﺑﻬﺘﺮﯾﻦ اﻧﺘﺨﺎبﻫﺎ ﺑﺮاي ﭘﻮﺷﺶ ﻧﻘﺎﯾﺺ ﮐﺎم در ﺑﯿﻤﺎران ﺑﺎ ﺷﮑﺎف ﮐﺎم وﺳﯿﻊ ﯾﺎ ﻓﯿﺴﺘﻮل ﻣﻘﺎوم ﺑﻪ درﻣﺎن ﻣﯽﺑﺎﺷﺪ. در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ﻣﻮﻓﻘﯿﺖ ﻓﻠﭗ ﺻﺪ در ﺻﺪ ﻫﺮ ﭼﻨﺪ در ﺣﺪود 18 درﺻﺪ ﺑﯿﻤﺎران ﻋﺎرﺿﻪ ﻋﺪم ﺗﺮﻣﯿﻢ ﮐﺎﻣﻞ ﻣﺸﺎﻫﺪه ﺷﺪ. ﻣﻬﻤﺘﺮﯾﻦ ﻋﯿﺐ اﯾﻦ ﻓﻠﭗ اﺛﺮات ﻧﺎزﯾﺒﺎ ﺷﺪن و اﺳﮑﺎر ﺳﺎﻋﺪ اﺳﺖ ﮐﻪ ﺑﺎﯾﺪ در ﻣﻘﺎﺑﻞ ﻣﺰاﯾﺎي زﯾﺎد آن ﻗﺮار داده ﺷﺪه و ﺗﺼﻤﯿﻢﮔﯿﺮي ﺷﻮد.
چكيده لاتين :
Introduction & Objective: Cleft Palate is the most common congenital craniofacial disorder with
prevalence about one in every 2000 births. In most of these patients, local and regional tissues in the mouth
are used to repair it. However, in cases of wide cleft palate or large and recurrent fistula, these methods are
not efficient and require the transfer of free flaps.
Materials & Methods: In this retrospective study, records of 17 patients with cleft palate or palatal
fistula that treated with free flaps were studied. The information includes age, sex, cause of surgery, type of
transferred flap, recipient artery and vein, size of skin paddle, pre-laminate or graft coverage of nasal side,
early flap survival, long-term results, effects on nasal regurgitation and velopharyngeal insufficiency were
collected. Data were analyzed by SPSS software version 19 and using descriptive statistics.
Results: The mean age of patients was 13.540 ± 15.705 (3-54 years). 10 (60%) were male and 7 (40%)
were female. 8 (47%) patients were operated due to wide cleft palate (WCP), 7 (41%) patients due to
recurrent palatal fistula (PF), one (6%) patient due to extensive tumor resection and one (6%) patient due to
extensive defect followed by Mucormycosis fungal infection in a diabetic patient. All the flaps survived,
and complete or partial necrosis were not observed. Nasal Regurgitation was cured in all but three patients
and Velopharyngeal insufficiency (VFI) was improved in all patients.
Conclusions: Radial Forearm Free Flap is one of the best choices to cover the defect in patients with a
wide cleft palate or a recurrent or large palatal fistula. In our study, the success rate was 100%, however, in
about 18% of patients, there was complications that needed another operation. The most important
disadvantage of this flap is the unaesthetic scar of forearm, which should be placed against its great
benefits.
