Guillemaud Jennifer P, Seikaly Hadi, Cote David W J, Barber Brittany R, Rieger Jana M, Wolfaardt Johan, Nesbitt Peggy, Harris Jeffrey R
Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, Room 1E4.29 Walter MacKenzie Health Science Centre, 8440-112 St, Edmonton, AB T6G 2R7, Canada.
Arch Otolaryngol Head Neck Surg. 2009 Apr;135(4):406-10. doi: 10.1001/archoto.2009.15.
To investigate the increasing use of double free flaps in the reconstruction of large head and neck defects.
A 5-year retrospective medical record review in a large tertiary care head and neck oncology program. Prospectively collected functional data were also analyzed.
Academic research.
A consecutive series of 35 patients (24 men and 11 women; mean age, 57.7 years).
The use of double free flaps in the reconstruction of large head and neck defects and prospective functional outcomes.
The most common indication for surgery (n = 25 [71.4%]) was squamous cell carcinoma. The most common double free-flap combination (n = 22 [62.9%]) included an osteocutaneous fibular free flap with a fasciocutaneous radial forearm free flap. Objective evaluation by naive listeners demonstrated a mean single-word intelligibility score of 66.2% and a mean sentence intelligibility score of 84.8% in this group of patients. Modified barium swallow study results revealed no evidence of laryngeal penetration for swallowing liquid consistencies in 21 patients (60.0%), pudding consistencies in 30 patients (85.7%), and cookie consistencies in 32 patients (91.4%).
With proper patient selection and planning and the use of 2 surgical teams, the length of surgery and complication rates are not significantly increased in double free-flap reconstruction. Furthermore, by using 2 free flaps, the best osseous and soft-tissue elements may be independently selected, yielding appropriate tissue characteristics for ideal defect reconstruction.
探讨在大型头颈部缺损重建中双游离皮瓣使用增加的情况。
在一个大型三级医疗头颈肿瘤项目中进行为期5年的回顾性病历审查。还对前瞻性收集的功能数据进行了分析。
学术研究。
连续35例患者（24例男性和11例女性；平均年龄57.7岁）。
双游离皮瓣在大型头颈部缺损重建中的使用情况及前瞻性功能结果。
最常见的手术指征（n = 25 [71.4%]）为鳞状细胞癌。最常见的双游离皮瓣组合（n = 22 [62.9%]）包括带骨皮瓣的腓骨游离皮瓣和带筋膜皮瓣的桡侧前臂游离皮瓣。由未接触过该组患者的听众进行的客观评估显示，该组患者的单字清晰度平均得分66.2%，句子清晰度平均得分84.8%。改良钡餐吞咽研究结果显示，21例患者（60.0%）吞咽液体时无喉穿透迹象，30例患者（85.7%）吞咽布丁样食物时无喉穿透迹象，32例患者（91.4%）吞咽饼干样食物时无喉穿透迹象。
通过适当的患者选择和规划以及使用两个手术团队，双游离皮瓣重建的手术时间和并发症发生率不会显著增加。此外，通过使用两个游离皮瓣，可以独立选择最佳的骨和软组织成分，从而为理想的缺损重建提供合适的组织特性。
