Sandel Henry D, Davison Steven P
Department of Otolaryngology, Georgetown University Hospital, Washington, DC 20007, USA.
J Reconstr Microsurg. 2007 May;23(4):225-30. doi: 10.1055/s-2007-981505.
We performed a retrospective chart review of a tertiary care medical center. Our objective was to report our experience with microvascular reconstruction in the head and neck in patients who presented with radiation-induced tissue damage. We will discuss the effects of radiation to soft tissues and bone in the head and neck as well as the challenges it presents for later free tissue transfer. Patients were identified who underwent free tissue transfer to the head and neck for radiation-induced tissue injury by the senior author at our institution. Data were collected to include location of the primary disease, radiation amount and zone of radiation injury, initial surgical reconstruction, time to development of radiation necrosis, type of free flap selected, recipient vessel selection, the number of sequential free tissue transfers, hyperbaric oxygen therapy, flap success rates, and minor complications. Patients were excluded if recurrent cancer was identified at any time following reconstruction. One hundred sixty-one free flaps were performed from 2000 to 2004 in the head and neck by the senior author at our tertiary care institution. Fourteen patients were identified who met the inclusion criteria and 16 (two lateral thigh, two iliac crest, one radial forearm, one transverse rectus abdominis, six fibula, two latissimus dorsi with associated rib, and two scapula) free flaps were performed for radiation-induced complications. Five patients required multiple sequential free flaps including the initial reconstruction. Anastomosis was performed within the radiation zone of injury in 14 cases (87.5%), whereas 2 (12.5%) were performed outside the zone of injury. Forty-three percent of patients ( N = 6) underwent hyperbaric oxygen therapy. After initial reconstruction, the incidence of complications requiring surgical intervention included skin breakdown ( N = 1), fistula ( N = 2), and persistent osteoradionecrosis ( N = 2). The mean time to follow-up was 17.5 months (range 1 to 49). There was one partial flap failure that was salvaged by thrombectomy. There were no total flap failures. As primary treatment for head and neck cancer moves toward radiation therapy, microsurgical reconstruction is playing an increasing role for those patients developing radiation-related complications. Radionecrosis is a progressive disease where the incidence is increasing as patients are surviving longer. Understanding the effects of radiation on soft tissue and bone and the complexity of reconstruction in the zone of injury will greatly improve the success of reconstruction.
我们对一家三级医疗中心进行了回顾性病历审查。我们的目的是报告我们在为出现放射性组织损伤的患者进行头颈部微血管重建方面的经验。我们将讨论辐射对头颈部软组织和骨骼的影响，以及它给后期游离组织移植带来的挑战。我们确定了由本机构资深作者为放射性组织损伤进行头颈部游离组织移植的患者。收集的数据包括原发疾病的位置、辐射剂量和辐射损伤区域、初始手术重建、放射性坏死发生的时间、所选游离皮瓣的类型、受区血管的选择、连续游离组织移植的次数、高压氧治疗、皮瓣成功率和轻微并发症。如果在重建后的任何时间发现复发性癌症，则将患者排除。2000年至2004年，本三级医疗机构的资深作者在头颈部进行了161例游离皮瓣手术。确定了14名符合纳入标准的患者，并为放射性并发症进行了16例（双侧大腿2例、髂嵴2例、桡侧前臂1例、腹直肌横行1例、腓骨6例、背阔肌带相关肋骨2例、肩胛骨2例）游离皮瓣手术。5名患者需要多次连续游离皮瓣，包括初始重建。14例（87.5%）在放射性损伤区域内进行吻合，而2例（12.5%）在损伤区域外进行吻合。43%的患者（N = 6）接受了高压氧治疗。初始重建后，需要手术干预的并发症发生率包括皮肤破损（N = 1）、瘘管（N = 2）和持续性放射性骨坏死（N = 2）。平均随访时间为17.5个月（范围1至49个月）。有1例部分皮瓣失败，通过取栓术挽救。没有完全皮瓣失败的情况。随着头颈部癌症的主要治疗方法转向放射治疗，显微外科重建在那些出现放射相关并发症的患者中发挥着越来越重要的作用。放射性坏死是一种进行性疾病，随着患者存活时间延长，其发生率正在增加。了解辐射对软组织和骨骼的影响以及损伤区域重建的复杂性将大大提高重建的成功率。
