Evaluacija uspješnosti rekonstrukcije usne šupljine podlaktičnim i perforatorskim režnjem

doctoral thesis

• Title (english): The effectivness of oral cavity reconstruction using forarm and perforator flaps
• Author: Merima Kasumović; VIAF: 227147662988060551229
• Mentor: Predrag Knežević (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2016-09-09, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

U istraživanje su bili uključeni bolesnici liječeni u Klinici za kirurgiju lica, čeljusti i usta
Kliničke bolnice „Dubrava“ u Zagrebu kod kojih je planirana rekonstrukcija podlaktičnim ili
perforatorskim režnjem. Ispitanici su bili svrstani u dvije skupine, prema vrsti
mikrovaskularnog režnja upotrijebljenog za rekonstrukciju nastalog defekta, a svaka je
skupina obuhvaćala minimalno 20 bolesnika. Postoperativni funkcijski rezultati ispitivani su
na redovitim kontrolama u ambulanti, inoviranim kliničkim specifičnim upitnikom. Dodatno
je bila provedena objektivna analiza glasa programom za akustičku analizu glasa Multi-
Dimensional Voice Program (MDVP).
Usna šupljina specifična je regija jer su međusobne relacije strukture i funkcije čvrsto
povezane. Nakon resekcije tumora nastali se defekt rekonstruira režnjem koji omogućuje
postoperativne funkcije žvakanja, gutanja, artikulacije glasova i govora. Postoperativna
protetska rehabilitacija, dužina hospitalizacije, lokalna komplikacija rekonstrukcije i
postoperativna radna aktivnost ne ovise o tipu režnja.
Dužina hospitalizacije ovisila je najprije o općem stanju bolesnika i komorbiditetu pa tek
onda o stadiju bolesti. Rezultati ovog istraživanja pokazuju da postoperativni dekanilman i
dužina hranjenja na nazogastričnu sondu ovise o stadiju bolesti neovisno o izboru režnja za
rekonstrukciju. Dekanilman je najbrži u stadiju I, a statistički je značajno brži u žena. Početak
prehrane na usta najbrži je u bolesnika koji su imali I. stadij bolesti te postoperativni govor.
Govor poslije operacije nije znatno ovisio o opsegu resekcije i tipu disekcije. U bolesnika u
objema skupinama postoperativni je govor, prema navodima bolesnika te prema procjeni
liječnika, bio znatno bolji u prvim mjesecima nakon kirurškog zahvata nego godinu dana

poslije. Ovo pogoršanje govora može se pojasniti ožiljkastim promjenama i atrofijom samoga
režnja. Većini bolesnika nije bio važan estetski izgled režnja (prekrivenost dlakama), koliko
im je bio važan izgled i funkcionalnost donorne regije te ukupni estetski dojam. Dobiveni
podaci pokazali su da uspjeh rekonstrukcije usne šupljine i bolja kvaliteta života bolesnika s
tumorom glave i vrata ne ovise izravno o metodi rekonstrukcije (tipu režnja).

Abstract (english)

The study included the patients treated at the Clinic for Maxillofacial Surgery at „Dubrava“
Clinic Hospital in Zagreb who were planned for microvascular reconstruction using forearm
or thigh perforator flaps. Patients with oral cavity cancer were evaluated and placed in two
groups (20 in each group), based on the type of perforator flap used for defect reconstruction.
Postoperative functional results were evaluated during regular follow up visits through a
specifically designed clinical questionnaire. Moreover, an objective voice analysis was done
using the acoustic voice analysis Multi-Dimensional Voice program (MDVP).
Oral cavity is a specific region, mostly due to the fact that most structures and functions are
closely interrelated. Tumor resection defects are commonly reconstructed with the most
adequate free flap which enables the patients to have reasonably normal functions of chewing,
swallowing, voice articulation and speech. Postoperative prosthetic rehabilitation, duration of
hospitalization, local complications with reconstruction and postoperative activity do not
depend on the flap type.
Length of hospitalization depended primarily on the general condition of the patient and
comorbidity and then on the stage of the ailment. The results of this study show that
postoperative decannulation and the duration of feeding through the nasogastric tube depends
on the stage of the ailment, regardless of the flap choice for reconstruction. Decannulation

was the fastest in stage 1, and statistically significantly faster in women. The fastest
postoperative mouth eating was in the patients who had stage 1 disease and postoperative
speech ability. Speech ability after surgery is not significantly dependent on the extent of
resection and the type of dissection. Postoperative speech in patients in both groups,
according to the patients and their physicians, was significantly better in the first months after
surgery than a year later. The deterioration of the speech ability can be explained by the scar
tissue and flap atrophy itself. The majority of patients were not concerned about the aesthetic
appearance of the flap (hair coverage), however, they were mostly concerned about the layout
and functionality of the donor region and the overall aesthetic impression. The data showed
that the success of oral cavity reconstruction and a better quality of life of patients with tumor
of head and neck do not directly depend on the reconstruction method.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:753068
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 133 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:09:32