Yoshimoto Seiichi, Kawabata Kazuyoshi, Mitani Hiroki
Department of Head and Neck, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, Japan.
Auris Nasus Larynx. 2010 Apr;37(2):205-11. doi: 10.1016/j.anl.2009.06.007. Epub 2009 Aug 22.
There have been few reports addressing methods of dealing with free flap thrombosis after reconstructive surgery for head and neck cancer. The present study, through a detailed analysis of the subsequent course of patients who developed postoperative flap thrombosis, aims to clarify possible methods of salvage surgery in the event of vascular occlusion despite rigorous postoperative follow-up.
We analyzed 59 cases of postoperative thrombosis in 1031 patients who underwent free flap transfer and considered the most appropriate salvage surgery in the event of total flap necrosis.
The flap salvage rate through vascular reanastomosis was highest for radial forearm flaps, with salvage of jejunal flaps being problematic if postoperative thrombosis occurred. For cases of postoperative thrombosis among patients who underwent reconstruction using a jejunal flap, the period of hospitalization was significantly extended for those patients in whom a second jejunal flap grafting was impossible. For cases of postoperative thrombosis among patients who underwent reconstruction using a radial forearm flap (FA), rectus abdominis flap (RA), or anterior lateral thigh flap (ALT), no significant difference was observed between those undergoing re-grafting with a free flap and those with a pedicled flap.
We concluded that, among patients who undergo reconstruction using a jejunal flap, thrombosis should be discovered at an early stage to enable another jejunal flap re-grafting. For patients who undergo reconstruction using a FA, RA, or ALT, if thrombosis can be discovered at an early stage, there is a possibility of salvaging the flap by means of vascular reanastomosis. If it should prove impossible to salvage the flap, however, primary suture of the defect or reconstruction with a pedicled flap may also be considered.
关于头颈癌重建手术后处理游离皮瓣血栓形成方法的报道较少。本研究通过对术后出现皮瓣血栓形成患者的后续病程进行详细分析，旨在明确即便术后进行了严格随访，在血管闭塞情况下可能的挽救手术方法。
我们分析了1031例行游离皮瓣移植患者中的59例术后血栓形成病例，并考虑了皮瓣完全坏死时最合适的挽救手术。
桡侧前臂皮瓣通过血管再吻合的皮瓣挽救率最高，空肠皮瓣术后发生血栓形成时挽救存在问题。对于行空肠皮瓣重建的患者术后血栓形成病例，无法进行第二次空肠皮瓣移植的患者住院时间显著延长。对于行桡侧前臂皮瓣（FA）、腹直肌皮瓣（RA）或股前外侧皮瓣（ALT）重建的患者术后血栓形成病例，游离皮瓣再次移植患者与带蒂皮瓣患者之间未观察到显著差异。
我们得出结论，在行空肠皮瓣重建的患者中，应早期发现血栓形成以便能进行另一次空肠皮瓣再次移植。对于行FA、RA或ALT重建的患者，如果能早期发现血栓形成，有可能通过血管再吻合挽救皮瓣。然而，如果证明无法挽救皮瓣，也可考虑对缺损进行一期缝合或用带蒂皮瓣进行重建。
