Division of Plastic & Reconstructive Surgery, University Health Network, 200 Elizabeth Street, 8N-865, Toronto, ON M5G 2C4, Canada.
J Plast Reconstr Aesthet Surg. 2012 Sep;65(9):1165-8. doi: 10.1016/j.bjps.2012.03.035. Epub 2012 Apr 8.
Ablative surgery for head and neck cancer often results in defects that require free flap reconstruction. Improved survival after refined oncologic and adjuvant techniques has led to an increase in the number of patients undergoing a second free flap reconstruction. The objective of this study was to assess outcomes following a second free flap in head and neck reconstruction.
Following ablative defects in the head and neck, 1475 patients underwent reconstructive surgery over a period of 17 years. A second free flap for reconstruction was performed on 123 of these patients. In Group 1, 93 patients had a reconstruction for either tumour recurrence, second primary tumour or reconstructive complications (fractured plate, osteoradionecrosis, orocutaneous fistula). In Group 2, 30 patients had a second free flap following primary free flap reconstructive failure.
Flap success for Group 1 patients was 86/90 (96%) compared to group 2 patients, 22/30 (73%) (p < 0.05). In Group 1, partial necrosis occurred in four patients whereas in Group 2, there was only one partial necrosis (NS; p > 0.05).
A second free flap may be required for reconstruction of head and neck defects following complications of the initial reconstruction, presence of a second primary or tumour recurrence. Success rates for second free flap reconstructions were significantly lower in those patients with initial free flap failure.
头颈部癌症的消融性手术通常会导致需要游离皮瓣重建的缺陷。经过改良的肿瘤学和辅助技术后，患者的生存率得到提高，这导致更多的患者需要进行第二次游离皮瓣重建。本研究的目的是评估头颈部重建后第二次游离皮瓣的结果。
在头颈部消融性缺陷后，1475 名患者在 17 年的时间内接受了重建手术。其中 123 名患者进行了第二次游离皮瓣重建。在第 1 组中，93 名患者因肿瘤复发、第二原发肿瘤或重建并发症（钢板骨折、放射性骨坏死或口-皮瘘）而进行重建。在第 2 组中，30 名患者因初次游离皮瓣重建失败而进行第二次游离皮瓣。
第 1 组患者的皮瓣成功率为 86/90（96%），而第 2 组患者的皮瓣成功率为 22/30（73%）（p<0.05）。第 1 组中有 4 名患者出现部分坏死，而第 2 组中只有 1 名患者出现部分坏死（NS；p>0.05）。
在初次重建并发症、第二原发肿瘤或肿瘤复发的情况下，可能需要第二次游离皮瓣来重建头颈部缺陷。在初次游离皮瓣重建失败的患者中，第二次游离皮瓣重建的成功率显著降低。
