Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA 94304-5715, USA.
J Plast Reconstr Aesthet Surg. 2011 Nov;64(11):1454-9. doi: 10.1016/j.bjps.2011.06.043. Epub 2011 Jul 23.
The introduction of radiotherapy (XRT) has resulted in increased survival of patients diagnosed with head and neck malignancies. However, the potentially deleterious impact of radiotherapy on reconstructive efforts continues to be the subject of intense debate. The present study was designed to evaluate the effects of preoperative XRT on complication rates in patients undergoing microsurgical reconstruction of head and neck defects after oncosurgical resection.
A retrospective cohort study was conducted of all patients who underwent immediate microsurgical reconstruction of post-ablative defects over a 3-year period. Study subjects were divided into two groups: (1) those who did not receive XRT and (2) those who received preoperative XRT. Clinical variables examined and analysed included age, gender, co-morbid conditions, tobacco history, the presence of recurrent disease and ischaemia time. Outcomes of interest included length of intensive care unit (ICU) and hospital stay and postoperative complications. Complications were further classified as flap-related as well as 'medical'.
A total of 60 patients were included in this study (group 1: 26 patients; group 2: 34 patients). Results were similar between the study groups with the exception of a higher rate of flap-related complications in patients undergoing XRT. Overall, 19 patients (31.7%) experienced flap-related complications, with 12% of the patients being in group 1 (N=3) versus 47% of patients being in group 2 (N=16) (p=0.003).
Our data suggest that preoperative radiotherapy is associated with a significant increase in postoperative flap-related complications. However, these did not result in a prolonged hospital stay, reflecting the fact that the majority of flap-related complications can be managed on an outpatient basis. Although microsurgical reconstruction is frequently successful, patients with a history of XRT should be informed preoperatively about their increased risk of complications.
放射治疗（XRT）的引入使头颈部恶性肿瘤患者的生存率提高。然而，放射治疗对重建工作的潜在有害影响仍然是激烈争论的主题。本研究旨在评估术前 XRT 对肿瘤切除后行头颈部缺损显微重建患者的并发症发生率的影响。
对 3 年内行即刻显微重建的所有患者进行回顾性队列研究。研究对象分为两组：（1）未接受 XRT 组；（2）接受术前 XRT 组。检查和分析的临床变量包括年龄、性别、合并症、吸烟史、疾病复发和缺血时间。感兴趣的结果包括重症监护病房（ICU）和住院时间以及术后并发症。并发症进一步分为皮瓣相关和“医疗”相关。
共有 60 例患者纳入本研究（组 1：26 例；组 2：34 例）。两组结果相似，除接受 XRT 的患者皮瓣相关并发症发生率较高外。总的来说，19 例患者（31.7%）发生皮瓣相关并发症，其中组 1 患者有 12%（N=3），组 2 患者有 47%（N=16）（p=0.003）。
我们的数据表明，术前放疗与术后皮瓣相关并发症显著增加相关。然而，这并没有导致住院时间延长，这反映了大多数皮瓣相关并发症可以在门诊管理。虽然显微重建通常是成功的，但有 XRT 史的患者应在术前告知其并发症风险增加。
