plasurВопросы реконструктивной и пластической хирургииIssues of Reconstructive and Plastic Surgery1814-1471АНО "НИИ микрохирургии"10.52581/1814-1471/80/08plasur-74Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУAID TO THE PHISICIANОпыт применения биневрального ALT-лоскута при реконструкции языкаExperience of application of binevral ALT-flap for tongue reconstructionhttps://orcid.org/0000-0002-0909-6278РешетовИ. В.ReshetovI. V.

Решетов Игорь Владимирович – д-р мед. наук, профессор, академик РАН, директор Института кластерной онкологии им. профессора Л.Л. Левшина, зав. кафедрой онкологии, радиотерапии и пластической хирургии Института клинической медицины им. Н.В. Склифосовского; зав. кафедрой онкологии и пластической хирургии

119991, г. Москва, ул. Трубецкая, 8, стр. 2

125371, г. Москва, Волоколамское ш., 91

Igor V. Reshetov, Dr. Med. sci., Professor, Academician of the RAS, Director of the Institute of Cluster Oncology named after Professor L.L. Levshin, head of the Department of Oncology, Radiotherapy and Plastic Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky; head of the Department of Oncology and Plastic Surgery

Bl. 2, 8, Trubetskaya st., Moscow, 119991

91, Volokolamskoe sh., Moscow, 125371 

reshetoviv@mail.ruhttps://orcid.org/0000-0002-1117-9427ЗакироваА. А.ZakirovaA. A.

Закирова Альбина Азатовна – аспирант кафедры онкологии, радиотерапии и пластической хирургии Института клинической медицины им. Н.В. Склифосовского; ст. преподаватель кафедры онкологии и пластической хирургии 

119991, г. Москва, ул. Трубецкая, 8, стр. 2

125371, г. Москва, Волоколамское ш., 91

Albina A. Zakirova, Postgraduate Student, the Department of Oncology, Radiotherapy and Plastic Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky; Senior Lecturer, the Department of Oncology and Plastic Surgery

Bl. 2, 8, Trubetskaya st., Moscow, 119991

91, Volokolamskoe sh., Moscow, 125371 

dr.zakirovasurg@gmail.comhttps://orcid.org/0000-0003-4598-8625СамойловаС. И.SamoilovaS. I.

Самойлова Светлана Ивановна – канд. мед. наук, доцент кафедры онкологии, радиотерапии и пластической хирургии Института клинической медицины им. Н.В. Склифосовского

119991, г. Москва, ул. Трубецкая, 8, стр. 2

Svetlana I. Samoilova, Cand. Med. sci., Associate Professor, the Department of Oncology, Radiotherapy and Plastic Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky

Bl. 2, 8, Trubetskaya st., Moscow, 119991 

sv_samoilova75@mail.ruПервый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский университет); Академия постдипломного образования ФГБУ «Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий ФМБА России»РоссияFirst Moscow State Medical University named after I.I. Sechenov (Sechenov University); Academy of Postgraduate Education, Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Federal Medical and Biological Agency of RussiaRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский университет)РоссияFirst Moscow State Medical University named after I.I. Sechenov (Sechenov University)Russian Federation2022060320222516576Copyright © Решетов И.В., Закирова А.А., Самойлова С.И., 20222022Решетов И.В., Закирова А.А., Самойлова С.И.Reshetov I.V., Zakirova A.A., Samoilova S.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://plasur.elpub.ru/jour/article/view/74

Цель исследования: оценить преимущества применения новой методики реконструкции языка после геми-, субтотальной и тотальной глоссэктомии биневральным кожно-мышечным лоскутом переднелатеральной поверхности бедра (ЛПЛПБ).Материал и методы. В период с 2020 по 2021 г. 4 пациенткам, у которых был диагностирован рак языка, выполнено радикальное хирургическое лечение с шейной лимфодиссекцией и одномоментной реконструкцией языка биневральным ЛПЛПБ, с выполнением невральных анастомозов: чувствительной ветви к большому ушному нерву, двигательной ветви к добавочной ветви подъязычного нерва.Результаты. Все пациентки находились в возрасте от 36 до 64 лет. Во всех случаях был диагностирован плоскоклеточный рак, стадии заболевания по TNM от II до IVa. Трахеостомия выполнялась в 3 из 4 случаев. Длительность пребывания в стационаре варьировала от 14 до 27 дней. Развитие послеоперационных осложнений не наблюдалось. Пероральный прием пищи был начат в среднем через 3 нед после операции. Декануляция выполнялась на сроках 3–4 нед после операции. Разборчивость речи оценивалась по 5-балльной шкале, у трех пациенток она была оценена как хорошая (4 балла), у 1 пациентки – как плохая (2 балла). Оценка глотания по 8-балльной шкале: 7 баллов у двух пациенток, 6 баллов – у одной пациентки, 4 балла – также у одной пациентки. Все сенсорные тесты были удовлетворительными по оцениваемым параметрам. Рецидива не наблюдалось.Заключение. Лоскут переднелатеральной поверхности бедра является перспективным для реконструкции языка благодаря возможности варьировать забор необходимого объема тканей для замещения различных дефектов, как при гемиглоссэктомии, так и при тотальной глоссэктомии. При этом лоскут имеет длинную сосудистую ножку и обладает преимуществами двойной реиннервации, что обеспечивает его функциональность.

The purpose of this study was to share our clinical experience of using a new technique for tongue reconstruction after hemi-, subtotal and total resection with a bineural musculocutaneous anterolateral thigh flap (ALT).Material and Methods. During the period from 2020 to 2021 four patients were diagnosed with oral cavity cancer and underwent radical surgical treatment with cervical lymphadenectomy and simultaneous tongue reconstruction using binerval ALT flap, with the performance of neural anastomoses of the sensitive branch to the great auricular nerve, and the motor branch to the accessory branch of the hypoglossal nerve.Results. All patients were aged 36 to 64 years.. Squamous cell carcinoma was diagnosed in all cases. Disease stages according to TNM were from II to IVa. Tracheostomy was performed in 3 out of 4 cases. The duration of hospital stay varied from 14 to 27 days. The development of postoperative complications was not observed. Oral meals were started on average 3 weeks after surgery. Decanulation in 3-4 weeks after surgery. Speech intelligibility was assessed on a scale, in 3 patients it was rated as good (4), in 1 patient it was poor (2). Swallowing score on a scale, 7 points in 2 patients, 6 points in 1 patient, 4 points in 1 patient. All sensory tests were satisfactory in all cases. No recurrence was observed.Conclusion. The ALT flap gained its popularity in tongue reconstruction due to a long and reliable vascular pedicle, the ability to vary the amount of tissue required to replace various defects, both in hemiglossectomy and in total glossectomy and low donor site morbidity. Also the flap has the advantages of double reinnervation, which ensures its functionality.

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The authors declare that there are no conflicts of interest present.