Wornom I L, Neifeld J P, Mehrhof A I, Young H F, Chinchilli V M
Department of Surgery, Medical College of Virginia/Virginia Commonwealth University, Richmond.
Am J Surg. 1991 Oct;162(4):408-11. doi: 10.1016/0002-9610(91)90160-f.
Resection of malignancies of the upper face and skull base may result in complex bone and soft tissue defects. To better define the optimal management of these defects, we conducted a retrospective review of 75 consecutive patients who underwent closure of 76 craniofacial defects after malignant tumor excision from 1966 to 1990. Wound complications requiring further surgery occurred in 30% of the defects (23 of 76). Wound complications at anterior, temporal, or combined sites were correlated with each method of reconstruction (scalp flap or split thickness skin graft, pedicled myocutaneous flap, and free flap). The presence of a large combined defect involving both frontal and temporal areas was the only significant risk factor for development of a wound complication requiring secondary surgery. These data suggest that anterior or temporal craniofacial defects may be closed with either scalp flaps and split thickness skin grafts or pedicled myocutaneous flaps with reasonable wound complication rates of 16% to 22%. Large combined defects have high wound complication rates (90%) when local tissue is used; therefore, other methods of closure such as free tissue transfer should be strongly considered in these patients.
上颌面部和颅底恶性肿瘤切除可能导致复杂的骨和软组织缺损。为了更好地确定这些缺损的最佳处理方法，我们对1966年至1990年间75例连续患者进行了回顾性研究，这些患者在恶性肿瘤切除后接受了76处颅面缺损的修复。30%的缺损（76处中的23处）出现需要进一步手术的伤口并发症。前部、颞部或联合部位的伤口并发症与每种重建方法（头皮瓣或断层皮片移植、带蒂肌皮瓣和游离皮瓣）相关。涉及额部和颞部的大型联合缺损的存在是发生需要二次手术的伤口并发症的唯一显著危险因素。这些数据表明，前部或颞部颅面缺损可用头皮瓣和断层皮片移植或带蒂肌皮瓣修复，伤口并发症发生率合理，为16%至22%。使用局部组织修复大型联合缺损时伤口并发症发生率很高（90%）；因此，对于这些患者应强烈考虑采用其他修复方法，如游离组织移植。
