Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon.
Head Neck. 2013 Oct;35(10):1468-70. doi: 10.1002/hed.23171. Epub 2012 Sep 13.
Over the last several decades, reconstruction of the head and neck oncologic defect has been revolutionized by the use of microvascular free tissue transfer. The majority of these defects can be reconstructed with the ability to visually monitor the flap, to intervene as soon as vascular compromise becomes evident. Occasionally, it is necessary to use a flap that has no visual external monitor: a buried free flap. A belief has circulated within the microvascular community that buried free flaps do not do as well as visible flaps. By our review, there are no recent data in the literature to support this position. We present our data on the outcomes of buried free flaps in microvascular reconstruction.
A single institutional retrospective review of 1492 flaps was performed between January 1999 and December 2011. A total of 103 free flaps (7.2%) were identified as meeting the criteria for a buried flap. It should be noted that all flaps with or without an external segment were monitored with an implantable Doppler. The flap failure and complications are defined as those failures or complications occurring within 2 weeks of surgery and related to the operation or to the flap itself.
In all, 5 of the 103 patients (4.9%) had complications requiring reoperative intervention. There were no instances of flap failure within the first 2 weeks of surgery.
In our series, there are no differences in flap failure rates comparing buried flaps to externally monitored flaps.
在过去的几十年中，通过使用游离微血管组织移植，头颈部肿瘤缺损的重建发生了革命性的变化。大多数这些缺损都可以通过能够直观监测皮瓣的方式来重建，如果血管受到影响，能够立即进行干预。偶尔，需要使用没有外部可视监测器的皮瓣：游离埋植皮瓣。游离埋植皮瓣的效果不如可见皮瓣，这一观点在微血管领域中流传。但通过我们的回顾，目前文献中没有支持这一观点的最新数据。我们介绍了游离埋植皮瓣在微血管重建中的结果数据。
对 1999 年 1 月至 2011 年 12 月期间 1492 例皮瓣进行了单机构回顾性研究。共有 103 例游离皮瓣（7.2%）符合埋植皮瓣的标准。需要注意的是，所有带有或不带有外部节段的皮瓣都通过植入式多普勒进行监测。皮瓣失败和并发症是指在手术后 2 周内发生的与手术或皮瓣本身有关的失败或并发症。
总共 103 例患者中有 5 例（4.9%）发生需要再次手术干预的并发症。在手术的前 2 周内，没有皮瓣失败的情况。
在我们的系列中，与外部监测皮瓣相比，埋植皮瓣的皮瓣失败率没有差异。
