Demirkan F, Wei F C, Chen H C, Chen I H, Hau S P, Liau C T
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taipei, Taiwan.
Plast Reconstr Surg. 1999 Mar;103(3):829-38. doi: 10.1097/00006534-199903000-00008.
Primary microsurgical reconstruction is the treatment of choice for ablative defects of oral carcinoma. As a result of this trend, more and more patients with recurrent oral carcinoma who have been initially treated with surgical excision and reconstructed with free flaps are being seen. However, a second microsurgical reconstruction attempt in these cases raises questions about the flap choices, availability of recipient vessels, and effects of previous treatment modalities. Herein, 35 patients with perioral carcinoma who had two successive tumor resections and reconstruction with free flaps on each occasion are presented. A total of 75 free tissue transfers were carried out for the first and second reconstructions. After the first tumor resection, 28 radial forearm fasciocutaneous flaps, 7 fibula osteoseptocutaneous flaps, 1 iliac osteomyocutaneous flap, and 2 rectus abdominis myocutaneous flaps were used. For reconstruction after the recurrence, 17 radial forearm fasciocutaneous flaps, 13 fibula osteoseptocutaneous flaps, 3 rectus abdominis myocutaneous flaps, 2 anterolateral thigh flaps, 1 jejunum flap, and 1 tensor fasciae latae flap were used. More vascularized bone transfers were performed during the second reconstruction since the excision for the recurrence frequently required segmental mandibulectomy. The complete flap survival rate was 97.3 percent and 94.6 percent with a reexploration rate of 7.9 percent and 13.5 percent for the first and second free tissue transfers, respectively. The mean follow-up time throughout the procedures was 37.5 months. Disease-free interval between reconstructions was 20.8 months. At the time of evaluation, 54.3 percent of the patients were surviving an average of 19 months since the second reconstruction. The results suggest that free flaps represent an important option in reconstruction of recurrent perioral carcinoma cases undergoing reexcision. When used in this indication they are as safe and effective as the initial procedure.
原发性显微外科重建是口腔癌切除性缺损的首选治疗方法。由于这一趋势，越来越多最初接受手术切除并用游离皮瓣重建的复发性口腔癌患者前来就诊。然而，在这些病例中进行第二次显微外科重建尝试引发了关于皮瓣选择、受区血管可用性以及先前治疗方式影响的问题。本文介绍了35例口周癌患者，他们每次均接受了两次连续的肿瘤切除并使用游离皮瓣进行重建。第一次和第二次重建共进行了75次游离组织移植。第一次肿瘤切除后，使用了28块桡侧前臂筋膜皮瓣、7块腓骨骨膜皮瓣、1块髂骨骨肌皮瓣和2块腹直肌肌皮瓣。复发后重建时，使用了17块桡侧前臂筋膜皮瓣、13块腓骨骨膜皮瓣、3块腹直肌肌皮瓣、2块股前外侧皮瓣、1块空肠皮瓣和1块阔筋膜张肌皮瓣。由于复发切除经常需要节段性下颌骨切除术，因此在第二次重建时进行了更多的带血管骨移植。第一次和第二次游离组织移植的完全皮瓣存活率分别为97.3%和94.6%，再次探查率分别为7.9%和13.5%。整个手术过程的平均随访时间为37.5个月。两次重建之间的无病间隔时间为20.8个月。在评估时，54.3%的患者自第二次重建后平均存活了19个月。结果表明，游离皮瓣是复发性口周癌再次切除后重建的重要选择。在此适应证中使用时，它们与初次手术一样安全有效。
