Nakamizo Munenaga, Yokoshima Kazuhiko, Yagi Toshiaki
Department of Otolaryngology, Head and Neck Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo 113-8603, Japan.
Auris Nasus Larynx. 2004 Sep;31(3):269-73. doi: 10.1016/j.anl.2004.03.003.
In order to clarify the factors affecting the survival of flaps, we performed a retrospective study on free flaps (187) used for reconstruction in head and neck surgery in 182 patients.
Free jejunum flaps were used on 68 occasions, rectus abdominus myocutaneous flaps on 67, radial forearm flaps on 49, scapular osteocutaneous flaps on 2 and latissimus dorsi myocutaneous flap on ones occasion, during the period from May 1996 to April 2003. Post-operative circulatory complications at the recipient site were analyzed mainly in relation to a history of previous surgery, radiotherapy and chemotherapy.
Circulatory crisis was observed in seven cases and circulation was restored in two of them after emergency exploration, whereas the other five flaps failed to survive. The overall failure rate of free flaps was 2.7%. Wound infection at the recipient site was frequent in patients with a history of previous local cervical surgery. Flap failure was significantly more frequent in patients with a history of previous surgery and infection, except for 2 patients in whose case the microsurgical technique was inadequate. Flap failure was not observed in those patients whose irradiation field could be analyzed, or in the patients who received chemotherapy. Although the incidence of circulatory crisis as a consequence of inadequate microsurgical technique was observed in the early period of this retrospective study, their frequency has diminished in the last 2 years.
The survival of flaps was affected by a history of previous surgery following wound infection, although a history of irradiation and chemotherapy would have no effects on flap failure. The appropriate choice of vessels and surgical skill are crucial for the success of free flaps from our experience. Emergency exploration was also crucial for the survival of the flap in the case of circulatory crisis.
为阐明影响皮瓣存活的因素，我们对182例患者头颈部手术中使用的187例游离皮瓣进行了回顾性研究。
在1996年5月至2003年4月期间，68次使用游离空肠皮瓣，67次使用腹直肌肌皮瓣，49次使用桡侧前臂皮瓣，2次使用肩胛骨皮瓣，1次使用背阔肌肌皮瓣。主要针对既往手术史、放疗史和化疗史分析受区术后循环并发症。
观察到7例出现循环危机，其中2例经急诊探查后循环恢复，而另外5例皮瓣未能存活。游离皮瓣的总体失败率为2.7%。既往有颈部局部手术史的患者受区伤口感染频繁。除2例显微外科技术欠佳的患者外，既往有手术史和感染史的患者皮瓣失败明显更频繁。在可分析照射野的患者或接受化疗的患者中未观察到皮瓣失败。虽然在这项回顾性研究早期观察到因显微外科技术欠佳导致循环危机的发生率，但在过去2年中其发生率已降低。
既往手术史伴伤口感染会影响皮瓣存活，而放疗史和化疗史对皮瓣失败无影响。根据我们的经验，合适的血管选择和手术技巧对游离皮瓣的成功至关重要。在出现循环危机时，急诊探查对皮瓣存活也至关重要。
