Pribaz Julian Joseph, Caterson Edward J
Harvard Medical School, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Craniofac Surg. 2013 Jan;24(1):99-107. doi: 10.1097/SCS.0b013e31827104ab.
Conventional reconstruction in the head and neck has undergone a revolution as microsurgery has evolved and expanded our ability to reconstruct the most difficult defects. Vascularized composite allotransplantation (VCA) has provided a new paradigm of options to restore in 1 stage what in the past has been performed in multiple stages with multiple combinations of free flaps and local flap options. This review demonstrates an evolving perspective of head and neck reconstructive surgery incorporating the indications and advantages gained over a career that has developed in parallel with microsurgery, prefabrication, prelamination, and face transplant. All current conventional reconstructions for the most severe defects often involve multistage procedures, using every rung of the reconstructive ladder, and the end results can still be lacking despite our best efforts. Despite all the tailoring and planning of these multiple flap and multiple-stage reconstructions, in our experience, these interventions never quite exactly recapitulate the face and fall short of full restoration. The early experience with VCA has been very promising and yields results that are superior to those achieved using conventional methods of reconstruction. However, it will be synergistic efforts in both VCA and conventional reconstruction to take us to the next level of full face restoration.
随着显微外科技术的发展以及我们修复最复杂缺损能力的提升，头颈部的传统重建技术经历了一场变革。血管化复合组织异体移植（VCA）提供了一种新的选择模式，能够一次性修复过去需要通过多种游离皮瓣和局部皮瓣组合、分多个阶段才能完成的修复。这篇综述展示了头颈部重建手术不断演变的观点，其中纳入了在与显微外科、预制、预分层和面部移植同步发展的职业生涯中所获得的适应证和优势。目前，针对最严重缺损的所有传统重建方法通常都涉及多阶段手术，需要动用重建阶梯的每一级，尽管我们已竭尽全力，但最终结果仍可能不尽人意。尽管对这些多皮瓣和多阶段重建进行了精心设计和规划，但根据我们的经验，这些干预措施从未完全精确地重现面部，也未能实现完全修复。VCA的早期经验非常令人鼓舞，其效果优于传统重建方法。然而，要将我们带到全脸修复的更高水平，需要VCA和传统重建技术的协同努力。
