Andrades Patricio, Bohannon Isaac A, Baranano Chris F, Wax Mark K, Rosenthal Eben
Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Microsurgery. 2009;29(3):171-7. doi: 10.1002/micr.20588.
This study describes the clinical setting and operative outcomes for simultaneous double free flap treatment of extensive composite head and neck cancers.
A retrospective review at two tertiary referral centers was performed. Patient demographics, cancer characteristics, reconstruction methods, and postoperative course were recorded. All patients were assessed for diet, speech, esthetics, socialization, and satisfaction using specific evaluation scales.
A total of 30 patients underwent double free flap reconstruction between 2001 and 2007. There were 19 men and 11 women, mean age of 62 years (range, 42-79). Comorbidities were present in 67% of the cases and 70% smoked. Most frequently the cancer was a squamous cell carcinoma (90%), in advanced stage (87%), and recurrent (67%), affecting the oral cavity (43%), larynx (23%) or pharynx (20%). The fibula osteoseptocutaneous/radial forearm fasciocutaneous flap combination was most commonly used (n = 13), followed by the jejunum-radial forearm flap (n = 10). Three flaps required early anastomosis revision and only two partial flap losses were observed. In 11 cases, there was a severe recipient site complication: wound dehiscence (n = 3), oral incompetence (n = 4), fistula (n = 2), and stenosis (n = 2). Two patients died in the postoperative period due to medical problems (7%). The mean follow up was 15.3 months. Patient satisfaction was poor to moderate and the overall functional evaluation score was low.
Double free flaps for one-stage reconstruction of extensive head and neck defects should be used in selected cases. Although a reliable procedure, immediate postoperative morbidity and mortality is high, and the long-term functional and esthetic results are modest. Realistic outcomes should be discussed with patients during planning and consent.
本研究描述了同期双游离皮瓣治疗广泛的头颈部复合癌的临床情况和手术结果。
在两个三级转诊中心进行了回顾性研究。记录了患者的人口统计学资料、癌症特征、重建方法和术后病程。使用特定评估量表对所有患者的饮食、言语、美观、社交和满意度进行评估。
2001年至2007年期间，共有30例患者接受了双游离皮瓣重建。其中男性19例，女性11例，平均年龄62岁（范围42 - 79岁）。67%的病例存在合并症，70%的患者吸烟。最常见的癌症是鳞状细胞癌（90%），处于晚期（87%）且为复发性（67%），累及口腔（43%）、喉（23%）或咽（20%）。最常使用的是腓骨骨皮瓣/桡侧前臂筋膜皮瓣组合（n = 13），其次是空肠 - 桡侧前臂皮瓣（n = 10）。3个皮瓣需要早期吻合口修复，仅观察到2例部分皮瓣丢失。11例患者出现严重的受区并发症：伤口裂开（n = 3）、口腔功能不全（n = 4）、瘘管（n = 2）和狭窄（n = 2）。2例患者术后因医疗问题死亡（7%）。平均随访时间为15.3个月。患者满意度为差至中等，总体功能评估得分较低。
一期重建广泛头颈部缺损的双游离皮瓣应在特定病例中使用。尽管该手术可靠，但术后早期发病率和死亡率较高，长期功能和美观效果一般。在规划和取得患者同意过程中，应与患者讨论实际结果。
