Kimerični režnjevi u rekonstrukciji defekata glave i vrata

master's thesis

• Title (english): Chimeric Flaps in Head and Neck Reconstructive Surgery
• Author: Viliam Tomljenović
• Mentor: Darko Solter (mentor)
• Committee member: Jakov Ajduk (predsjednik povjerenstva)
• Committee member: Mihael Ries (član povjerenstva)
• Committee member: Darko Solter (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Po Hallockovoj definiciji, kimerični režanj predstavlja skup multiplih režnjeva od kojih svaki ima zasebnu vaskularnu opskrbu, ali su sve pojedinačne žile takvoga režnja povezane na jedinstvenu krvožilnu peteljku. Jedinstvena krvožilna peteljka podrazumijeva uspostavljanje jedne mikrovaskularne anastomoze u usporedbi s multiplim anastomozama u rekonstrukciji defekata višestrukim slobodnim režnjevima. Navedeno značajno smanjuje operativno vrijeme i rizik nastanka perioperativnih komplikacija. Ovakvi su režnjevi idealni za rekonstrukciju golemih defekata glave i vrata jer omogućuju sinkroni prijenos velikih količina različitih tipova tkiva u jednome aktu. Uporabom ovih tehnika bolesnika se pošteđuje višestrukih operacijskih zahvata te se smanjuje vjerojatnost morbiditeta donorskog mjesta. Estetski rezultati ovakvih rekonstrukcija često su bolji od onih postignutih konvencionalnim rekonstrukcijama pomoću više slobodnih režnjeva. Klasifikacija kimeričnih režnjeva podrazumijeva njihovu kategorizaciju na intrinzične i prefabricirane režnjeve. Intrinzični kimerični režanj zasniva se na intrinzičnoj vaskularnoj opskrbi tkiva koje se odiže i prati prirodnu anatomsku distribuciju krvnih žila u tijelu. Unutar ove skupine razlikujemo granaste i perforatorske intrinzične kimerične režnjeve. S druge strane, prefabricirani kimerični režanj predstavlja kimerično tkivo čije se komponente, po zasebnom odizanju, spajaju ekstrakorporalno kirurškom mikroanastomozom te potom prenose na mjesto defekta. Unatoč mnogostrukim prednostima, mane uporabe kimeričnih režnjeva povezuju se s anatomskim varijacijama vaskularne opskrbe, zbog čega njihova primjerna zahtjeva adekvatnu predoperativnu obradu. Povrh toga, ovakva tehnika rekonstrukcije zahtijeva veliko iskustvo kirurškog tima koji mora biti brojčano i logistički dostatan za istovremeno odizanje režnja na razini donorske regije i resekciju tkiva na razini primateljske regije.

Abstract (english)

According to Hallock's definition, a chimeric flap represents a set of multiple flaps, each with a separate vascular supply, with all individual vessels of such flap connected to a single vascular pedicle. A single vascular pedicle implies the establishment of singular microvascular anastomosis compared to multiple anastomoses in reconstructing defects with multiple free flaps. This significantly reduces operative time as well as the risk of perioperative complications. These flaps are ideally suited for the reconstruction of large defects of the head and neck as they facilitate the synchronous transfer of substantial quantities of various tissue types in a single procedure. These techniques spare the patient from undergoing multiple surgical procedures and reduce the likelihood of donor site morbidity. The aesthetic outcomes of such reconstructions often surpass those achieved with conventional reconstruction using several free flaps. The classification of chimeric flaps categorizes them into two major groups - intrinsic and prefabricated. The intrinsic chimeric flap is based on the intrinsic vascular supply of the tissue and follows the natural anatomical distribution of blood vessels in the body. Within this group, branch-based and perforator-based intrinsic chimeric flaps can be distinguished. Conversely, the prefabricated chimeric flap comprises a chimeric tissue whose components, after being separately removed, are joined extracorporeally by surgical microvascular anastomosis. Despite their numerous advantages, the disadvantages of using chimeric flaps are associated with various anatomical variations of the vascular supply, which is why their utilization requires an adequate preoperative evaluation. Additionally, this reconstruction method requires an experienced surgical team which must be logistically sufficient for simultaneous utilization of the flap at the donor site as well as the tissue resection at the recipient region.

• Keywords: kimerični režanj; rekonstrukcija defekata; kirurgija glave i vrata
• Keywords (english): chimeric flaps; reconstruction of defects; head and neck surgery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:207927
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-05-23 09:00:41