Deleyiannis Frederic W-B, Rogers Carolyn, Lee Edward, Russavage James, Gastman Brian, Dunklebarger Joshua, Lai Stephen, Ferris Robert, Myers Eugene N, Johnson Jonas
Division of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Laryngoscope. 2006 Nov;116(11):2071-80. doi: 10.1097/01.mlg.0000240858.88538.e1.
To examine how the accompanying soft tissue resection of the oral cavity, oropharynx, neck, or face affects the reconstructive management of the lateral mandibulectomy defect.
Retrospective review of 76 consecutive patients.
Patient and tumor variables were extracted from the medical records. Outcomes that were examined included method of reconstruction, medical complications, flap complications, and survival.
Age greater than 70 years (P = .03), moderate or severe comorbidity (P = .01), and tumor involvement of the base of tongue (P = .03) were significantly associated with decreased use of a free flap and with decreased 3-year survival rates. For choice of free (osteocutaneous radial forearm free flap or fibula vs. rectus abdominis) and regional flaps (pectoralis or cervicodeltopectoral), lateral defects could be classified into one of three types: type 1 (n = 60), lateral defect with a soft tissue resection limited to the oral cavity and oropharynx; type 2 (n = 11), lateral defect with a through and through defect of the lower one third of the face (skin overlying the mandible) or neck; and type 3 (n = 5), lateral defect with an associated large-volume resection of the midface, parotid, or cheek skin.
When the lateral mandible is resected with an accompanying large soft tissue defect of the neck or face (type 2 or type 3 defect), the reconstructive challenge becomes the determination of how best to cover the planned bony reconstruction or whether to perform only a soft tissue reconstruction. When placed in the context of expected prognosis, the proposed classification system based on the location and volume of the associated soft tissue resection can help guide the reconstructive options for these decisions.
探讨口腔、口咽、颈部或面部的软组织切除术如何影响下颌骨外侧切除术缺损的重建处理。
对76例连续患者进行回顾性研究。
从病历中提取患者和肿瘤变量。所检查的结果包括重建方法、医疗并发症、皮瓣并发症和生存率。
年龄大于70岁（P = 0.03）、中度或重度合并症（P = 0.01）以及舌根肿瘤累及（P = 0.03）与游离皮瓣使用减少和3年生存率降低显著相关。对于游离皮瓣（桡侧前臂游离骨皮瓣或腓骨瓣与腹直肌瓣）和区域皮瓣（胸大肌瓣或颈阔肌胸大肌瓣）的选择，外侧缺损可分为三种类型之一：1型（n = 60），外侧缺损且软组织切除限于口腔和口咽；2型（n = 11），外侧缺损且面部下三分之一（下颌骨上方皮肤）或颈部贯通性缺损；3型（n = 5），外侧缺损且伴有中面部、腮腺或颊部皮肤的大面积切除。
当下颌骨外侧切除伴有颈部或面部的大软组织缺损（2型或3型缺损）时，重建的挑战在于确定如何最佳地覆盖计划中的骨重建或是否仅进行软组织重建。在预期预后的背景下，基于相关软组织切除的位置和范围提出的分类系统有助于指导这些决策的重建选择。
