Zhang Bi, Yamada Atsushi
Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100021, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005 Oct;19(10):777-9.
To choose suitable free flaps for reconstructing head and neck defects caused by tumor resection.
A retrospective analyses was made in 86 cases of head and neck defects treated with four kinds of free flaps between January 1999 and January 2002. The head and neck defects were caused by tumor resection. The locations were oral cavity (n=32), hypopharynx (n=27), mandible (n=12), skull base (n=5), scalp and skin (n=6) and midface (n=4). The donor sites of free flaps included the rectus abdominis (n=32), anterolateral thigh (n=10), jejunum (n=25), fibula (n=11), latissimus dorsi (n=4), forearm (n=3) and scapula (n=1). The sizes of the cutaneous/musculocutaneous flaps ranged from 4 cm x 5 cm to 14 cm x 24 cm. The lengths of the fibula were 4-16 cm, of jejunum 9-20 cm.
The overall free flap success rate was 92% (79/86). Of 32 oral cavity defects, 22 were reconstructed by rectus abdominis (69%) and 10 by anterolateral thigh flaps (31%). Of 27 hypopharyngeal defects, 25 were restored by jejunum flaps (93%). Eleven of 12 mandibular defects were reconstructed by fibula flaps (92%). Four of 5 defects of skull base were reconstructed by rectus abdominis flaps (80%). The free flaps of rectus abdominis, anterolateral thigh, jejunum and fibula were most frequently used, accounting for 91% (78/86) of all flaps in head and neck defect reconstruction.
Although head and neck defects represent a complicated spectrum of subsites and loss, these four free flaps can manage most reconstruction problems.
选择合适的游离皮瓣用于修复肿瘤切除术后所致的头颈部缺损。
对1999年1月至2002年1月间采用4种游离皮瓣治疗的86例头颈部缺损患者进行回顾性分析。头颈部缺损由肿瘤切除引起。部位包括口腔（n = 32）、下咽（n = 27）、下颌骨（n = 12）、颅底（n = 5）、头皮及皮肤（n = 6）和中面部（n = 4）。游离皮瓣的供区包括腹直肌（n = 32）、股前外侧（n = 10）、空肠（n = 25）、腓骨（n = 11）、背阔肌（n = 4）、前臂（n = 3）和肩胛骨（n = 1）。皮瓣/肌皮瓣大小为4 cm×5 cm至14 cm×24 cm。腓骨长度为4 - 16 cm，空肠长度为9 - 20 cm。
游离皮瓣总体成功率为92%（79/86）。3旦例口腔缺损中，22例采用腹直肌修复（69%），1旦例采用股前外侧皮瓣修复（31%）。27例下咽缺损中，25例采用空肠瓣修复（93%）。12例下颌骨缺损中，11例采用腓骨瓣修复（9旦%百。5例颅底缺损中，4例采用腹直肌皮瓣修复（80%）。腹直肌、股前外侧、空肠和腓骨游离皮瓣最常用，占头颈部缺损修复所用皮瓣总数的91%（78/86）。
尽管头颈部缺损部位复杂多样、组织缺失情况各异，但这4种游离皮瓣可解决大多数修复问题。
