Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
Oral Oncol. 2012 Apr;48(4):367-71. doi: 10.1016/j.oraloncology.2011.11.013. Epub 2011 Dec 11.
Despite the refinement of microsurgical techniques, microsurgical free flap transfer in patients with a history of previous radiotherapy, neck dissection or free flaps remains a challenge in oncologic reconstructive surgery. Previous studies on the prognostic factors for postoperative complications have been largely retrospective and shown conflicting results. Our aim was to design a prospective study to identify negative outcome predictors of free flap surgery in previously treated oral cancer patients. Prospective study including all patients who required microsurgical free flap transfer for reconstruction of the oral cavity between July of 2007 and June of 2010 with subset analysis of those cases in whom previous surgical or nonsurgical oncological treatment for head and neck cancer had been carried out. A total of 360 free flaps were performed in 358 patients, of whom 61 had previous neck dissection and 58 had undergone radiation therapy. Operation time was significantly found to be longer in irradiated patients. The need for microsurgical revision, postoperative wound infection and free flap loss were significantly associated with the ASA score and a previous neck dissection. Wound infection was seen significantly more often after radiotherapy. Previous neck dissections and radiotherapy as well as the ASA score are significant negative predictors for success in free flap transfer. For patients with prior oncologic treatments in their medical history, we recommend detailed preoperative assessment of the vascular status and an intensified postoperative care to reduce complication rates to improve outcome in oncologic reconstructive surgery.
尽管显微外科技术不断完善，但对于有既往放疗、颈部清扫或游离皮瓣史的患者，进行显微外科游离皮瓣移植仍然是肿瘤重建外科的一个挑战。既往关于术后并发症预后因素的研究大多是回顾性的，结果相互矛盾。我们旨在设计一项前瞻性研究，以确定既往接受过治疗的口腔癌患者游离皮瓣手术的负面结果预测因素。这是一项前瞻性研究，纳入了 2007 年 7 月至 2010 年 6 月期间所有因口腔重建而需要行显微外科游离皮瓣移植的患者，其中还包括了既往接受过头颈部癌症手术或非手术治疗的患者亚组分析。共有 358 例患者接受了 360 个游离皮瓣，其中 61 例有既往颈部清扫史，58 例接受过放疗。结果发现，接受放疗的患者手术时间明显较长。需要显微外科修正、术后伤口感染和游离皮瓣丢失与美国麻醉师协会（ASA）评分和既往颈部清扫显著相关。放疗后伤口感染明显更为常见。既往颈部清扫、放疗以及 ASA 评分是游离皮瓣移植成功的显著负性预测因素。对于有既往肿瘤治疗史的患者，我们建议在术前详细评估血管状态，并加强术后护理，以降低并发症发生率，从而改善肿瘤重建外科的治疗效果。
