Department of Surgery, Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103 Nice, France.
J Plast Reconstr Aesthet Surg. 2013 Apr;66(4):478-82. doi: 10.1016/j.bjps.2012.12.019. Epub 2013 Jan 23.
The primary objective of this study was to evaluate the impact of preoperative radiotherapy on the outcomes of head and neck microvascular reconstruction. The secondary objective was to assess the specific effects of irradiation doses (IDs) ≥60 Gy on the outcomes of head and neck microvascular reconstruction.
All patients who underwent head and neck free-flap reconstruction in our institution between 2000 and 2010 were included in this retrospective study. A total of 429 patients were enrolled including 136 patients previously irradiated on the head and neck. The impact of preoperative radiotherapy on free-flap success, local and general complications, postoperative mortality, time of decannulation, duration of enteral nutrition and length of stay was assessed in univariate and multivariate analyses.
In multivariate analysis, preoperative radiotherapy (irrespective of ID) was a significant risk factor for fistula formation (p = 0.003) and wound infection (p = 0.005). Previous neck irradiation at doses ≥60 Gy was associated with an increased risk of free-flap failure (p = 0.04), overall local complications (p = 0.05), haematoma (p = 0.04) and longer duration of enteral nutrition (p = 0.006) and hospital stay (p = 0.004).
Preoperative radiotherapy, particularly for ID ≥ 60 Gy, is one of the main determinants of the outcomes of head and neck microvascular reconstruction.
本研究的主要目的是评估术前放疗对头颈部微血管重建结局的影响。次要目的是评估照射剂量（ID）≥60Gy 对头颈部微血管重建结局的具体影响。
本回顾性研究纳入了 2000 年至 2010 年间在我院行头颈部游离皮瓣重建的所有患者。共纳入 429 例患者，其中 136 例患者头颈部曾接受过放疗。在单因素和多因素分析中评估了术前放疗对头颈游离皮瓣成功、局部和全身并发症、术后死亡率、拔管时间、肠内营养时间和住院时间的影响。
多因素分析显示，术前放疗（不论 ID 如何）是瘘形成（p=0.003）和伤口感染（p=0.005）的显著危险因素。剂量≥60Gy 的颈部既往放疗与游离皮瓣失败（p=0.04）、总局部并发症（p=0.05）、血肿（p=0.04）、肠内营养时间（p=0.006）和住院时间（p=0.004）延长有关。
术前放疗，特别是 ID≥60Gy，是头颈部微血管重建结局的主要决定因素之一。
