Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea.
Eur Arch Otorhinolaryngol. 2011 Jul;268(7):1061-5. doi: 10.1007/s00405-010-1450-5. Epub 2010 Dec 4.
Postoperative volume changes in reconstructed flaps are known to influence the functional restoration of resected areas of the upper aerodigestive tract. The purposes of this study were to estimate the volume decreases in flaps and investigate clinical factors affecting the volume decrease. The medical records of 19 patients who underwent ablation and flap reconstruction surgeries for head and neck cancers were reviewed. The volume of the reconstructed flap was measured at 3, 12, and 24 months postoperatively using CT or MR imaging and the 3D-DOCTOR software. The relationships between volume changes and perioperative clinical parameters were examined. The primary tumor locations were the nasal cavity and paranasal sinus, oropharynx, oral cavity, and hypopharynx in 8, 6, 4, and 1 case, respectively. Twelve patients underwent anterolateral thigh flap (ALTF) reconstruction, and seven patients underwent pectoralis major myocutaneous flap (PMMCF) reconstruction. Twelve (63.2%) patients received postoperative radiation. The estimated volume decreases at 12 and 24 months postoperatively for ALTF were 20.9 and 24.8%, respectively, while those for PMMCF were 7.3 and 10.8%, respectively. Among clinical factors, only the type of flap affected the volume change. When determining the volume of reconstructed flaps, the type of flap must be considered. It was recommended to make free and regional flaps at least 20 and 10% larger, respectively than the actual defect.
重建皮瓣的术后体积变化已知会影响上呼吸道切除区域的功能恢复。本研究的目的是估计皮瓣的体积减少，并研究影响体积减少的临床因素。回顾了 19 例因头颈部癌症而行消融和皮瓣重建手术的患者的病历。使用 CT 或 MR 成像和 3D-DOCTOR 软件在术后 3、12 和 24 个月测量重建皮瓣的体积。检查了体积变化与围手术期临床参数之间的关系。原发肿瘤部位分别为 8 例鼻腔和鼻窦、6 例口咽、4 例口腔和 1 例下咽。12 例患者接受股前外侧皮瓣（ALTF）重建，7 例患者接受胸大肌肌皮瓣（PMMCF）重建。12 例（63.2%）患者接受术后放疗。术后 12 个月和 24 个月时，ALTF 的估计体积减少分别为 20.9%和 24.8%，而 PMMCF 则分别为 7.3%和 10.8%。在临床因素中，只有皮瓣类型影响体积变化。在确定重建皮瓣的体积时，必须考虑皮瓣类型。建议游离皮瓣和区域性皮瓣的实际缺损至少要大 20%和 10%。
