Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
J Craniomaxillofac Surg. 2013 Jan;41(1):2-6. doi: 10.1016/j.jcms.2012.05.004. Epub 2012 Jul 5.
Microsurgical tissue transfer is a standard procedure in reconstructive surgery of defects in head and neck oncology patients. According to the literature vascular thrombosis occurs in 8-14% of cases and is considered to be the main reason for flap failure. A review of the literature on this subject was carried out and related to the quality guidelines of the Department of Cranio-Maxillofacial Surgery in the Maastricht University Medical Centre. We defined quality indicators and quality goals for the reconstruction of head and neck defects. We investigated whether or not these parameters are practicable in a specialized head and neck cancer unit.
We included 81 consecutive patients with oral cancer/osteoradionecrosis of the mandible who received a microsurgical free tissue transfer for reconstruction. The patients were treated in our institution between August 2007 and December 2011. Patient data were collected in a prospective database. Follow-up was conducted in the Department of Cranio-Maxillofacial Surgery. Data were analysed for the defined reference groups, and the results were compared with the quality goals.
Median follow-up was 29.1 (range 1-55) months. There were only six (7.4%) immediate complications leading to compromised flaps. Among the complications were four (5.0%) anastomosis-related complications and two haematomas (2.5%). There was no flap loss. Based on the quality goals we were able to reach an overall flap success rate of 100%.
Most of the defined quality goals can be attained in a specialized head and neck unit. Careful patient selection, pharmacologic, non-pharmacologic and surgical measures for preventing thrombosis, such as meticulous micro-vascular surgery are considered to be essential. No consensus in the literature was found on how complications could best be prevented. The role of a standardized pre-, peri- and postoperative management is presented. The importance of thorough planning and the technical skill of the reconstructive surgeon are highlighted. The debate on quality goals has the potential to enable further improvement in the care of head and neck cancer patients.
显微组织移植是头颈部肿瘤患者缺损重建外科的标准程序。根据文献，血管血栓形成发生在 8-14%的病例中，被认为是皮瓣失败的主要原因。对这一主题的文献进行了回顾，并与马斯特里赫特大学医学中心颅面外科的质量指南相关。我们定义了头颈部缺损重建的质量指标和质量目标。我们调查了这些参数在专门的头颈部癌症单位是否可行。
我们纳入了 81 例连续接受口腔癌/下颌骨放射性骨坏死的患者，他们接受了显微游离组织移植进行重建。这些患者于 2007 年 8 月至 2011 年 12 月在我们机构接受治疗。患者数据在一个前瞻性数据库中收集。随访在颅面外科进行。对定义的参考组进行了数据分析，并将结果与质量目标进行了比较。
中位随访时间为 29.1 个月（范围 1-55 个月）。只有 6 例（7.4%）发生了即时并发症，导致皮瓣受损。并发症包括 4 例（5.0%）吻合口相关并发症和 2 例血肿（2.5%）。没有皮瓣坏死。根据质量目标，我们能够达到 100%的总体皮瓣成功率。
大多数定义的质量目标可以在专门的头颈部单位实现。仔细的患者选择、预防血栓形成的药物、非药物和手术措施，如精细的微血管手术，被认为是至关重要的。在文献中没有找到关于如何最好地预防并发症的共识。提出了标准化的术前、术中和术后管理的作用。强调了彻底的计划和重建外科医生的技术技能的重要性。关于质量目标的讨论有可能使头颈部癌症患者的护理得到进一步改善。
