游离皮瓣重建下颌骨放射性骨坏死：10 年回顾与缺损分类。
Free flap reconstruction of osteoradionecrosis of the mandible: a 10-year review and defect classification.
机构信息
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
Head Neck. 2011 Jun;33(6):800-7. doi: 10.1002/hed.21537. Epub 2010 Nov 12.
BACKGROUND
The purpose of this study was to evaluate outcomes of free flap reconstruction for advanced osteoradionecrosis (ORN) defects and develop an algorithm to guide surgical planning.
METHODS
All cases involving free flap reconstruction for ORN of the mandible between 1998 and 2008 were reviewed. A defect classification scheme was developed. Flap selection and outcomes were analyzed and evaluated by defect type.
RESULTS
Seventy-five free flaps and 13 pedicle flaps were performed in 63 patients. Total flap loss was 5%. Overall surgical complication was 32%. Complication rates were higher with bone flaps than with soft tissue flaps (p = .018). A full oral diet was tolerated in 57% of patients, whereas 26% required partial tube feeding, and 16% were tube-feeding dependent.
CONCLUSION
Free flap reconstruction of advanced ORN defects can be safely performed in a variety of flap configurations with good outcomes. The classification scheme may assist in flap selection.
背景
本研究旨在评估游离皮瓣重建治疗晚期放射性骨坏死（ORN）缺损的效果，并制定一种算法来指导手术规划。
方法
回顾了 1998 年至 2008 年间所有接受游离皮瓣重建治疗下颌骨 ORN 的病例。制定了一种缺损分类方案。根据缺损类型分析和评估皮瓣选择和结果。
结果
63 例患者共进行了 75 次游离皮瓣和 13 次带蒂皮瓣手术。总的皮瓣失活率为 5%。总的手术并发症发生率为 32%。骨瓣的并发症发生率高于软组织瓣（p =.018）。57%的患者可以耐受全口饮食，26%需要部分管饲，16%需要依赖管饲。
结论
游离皮瓣重建治疗晚期 ORN 缺损可在多种皮瓣类型中安全进行，效果良好。该分类方案可能有助于皮瓣选择。
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