Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
Laryngoscope. 2014 Jun;124(6):1329-35. doi: 10.1002/lary.24383. Epub 2013 Oct 1.
OBJECTIVES/HYPOTHESIS: To characterize the changing indications for osseous free flaps in maxillomandibular reconstruction at our institution.
Retrospective chart review.
Database review of patients who underwent free-flap reconstruction of the jaws using vascularized bone-containing free tissue transfer from 1995 to 2012 at the University of California Los Angeles (UCLA).
A total of 620 osseous free flaps were performed. The most common indications for surgery were squamous cell carcinoma (n = 442) and osteoradionecrosis (ORN)) of the mandible (n = 73). There were no significant differences in 90-day perioperative complication, flap viability, or mortality rates between any of the indications for surgery. Patients older than 60 years had a higher rate of major perioperative complication (P = 0.0028). ORN cases represented 1.3% ± 1.2% of surgical volume from 1995 to 2000, 8.7% ± 1.8% from 2001 to 2006, and 17.5% ± 2.2% from 2007 to 2012 (P <0.0001). Among cases of ORN, 95.8% of patients had radiation therapy completed at centers outside of our hospital system. For patients with ORN, there was an average interval of 8.7 ± 8.0 years from initiation of radiotherapy to the date of mandibulectomy (range 1-37 years).
The incidence of ORN as an indication for free-flap reconstruction has increased at our institution in recent years. This may reflect an increasing need for the surgical management of medically refractory ORN, a rising awareness or prevalence of ORN overall, and/or increasing comfort with free flaps as a treatment for ORN. Patients who undergo free-flap surgery for ORN do not have greater risks of 90-day perioperative complications or differences in free-flap viability as compared to patients who undergo free-flap reconstruction for other indications.
2b.
目的/假设：描述我们机构中颌骨重建中骨游离皮瓣的适应证变化。
回顾性图表回顾。
对 1995 年至 2012 年在加利福尼亚大学洛杉矶分校（UCLA）接受带血管骨游离组织移植的游离皮瓣重建颌骨的患者进行数据库回顾。
共进行了 620 例骨游离皮瓣手术。手术的最常见适应证是鳞状细胞癌（n=442）和下颌骨放射性骨坏死（ORN）（n=73）。任何手术适应证之间，90 天围手术期并发症、皮瓣存活率或死亡率均无显著差异。年龄大于 60 岁的患者主要围手术期并发症发生率较高（P=0.0028）。1995 年至 2000 年，ORN 占手术量的 1.3%±1.2%，2001 年至 2006 年占 8.7%±1.8%，2007 年至 2012 年占 17.5%±2.2%（P<0.0001）。在 ORN 病例中，95.8%的患者在我院系统外的中心完成了放射治疗。对于 ORN 患者，从开始放疗到行下颌骨切除术的平均间隔为 8.7±8.0 年（范围 1-37 年）。
近年来，我们机构 ORN 作为游离皮瓣重建适应证的发生率有所增加。这可能反映了对医学难治性 ORN 的手术治疗需求增加，ORN 整体的认识或流行率上升，以及/或对游离皮瓣治疗 ORN 的接受程度增加。与接受游离皮瓣重建其他适应证的患者相比，接受游离皮瓣手术治疗 ORN 的患者 90 天围手术期并发症风险或游离皮瓣存活率无差异。
2b。
