Trivedi Nirav P, Trivedi Pravin, Trivedi Harish, Trivedi Saroj, Trivedi Nirali
Department of Plastic Surgery, Trivedi Polyclinic and Nursing Home, Mehsana, Gujarat, India ; Department of Plastic Surgery, Mazumdar Shaw Cancer Center and NH, Bangalore, India.
Indian J Plast Surg. 2013 Jan;46(1):82-6. doi: 10.4103/0970-0358.113715.
Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialised procedure and is not routinely performed in the resource-constrained environment of certain developing parts of India.
This article focuses on the practice environment in a cancer clinic in rural India. Availability of infrastructure, selection of the case, choice of flap, estimation of cost and complications associated with treatment are evaluated and the merits and demerits of such an approach are discussed.
We performed 22 cases of free flaps in a six-month period (2008-2009). Majority (17) of the patients had oral cancer. Seven were related to the tongue and eight to the buccal mucosa. Radial forearm free flap (RFF: 9) and anterolateral thigh flap (ALT: 9) were the most commonly used flaps. A fibula flap (1) was done for an anterior mandible defect, whereas a jejunum free flap (1) was done for a laryngopharyngectomy defect. There were six complications with two re-explorations but no loss of flaps.
Reconstruction with microvascular free flaps is feasible in a resource-constrained setup with motivation and careful planning.
游离皮瓣重建显著改变了头颈癌患者的治疗结果。显微外科手术仍被视为一种专科手术，在印度某些发展中地区资源有限的环境中并非常规开展。
本文聚焦于印度农村一家癌症诊所的实际手术环境。评估了基础设施的可用性、病例选择、皮瓣选择、成本估算以及与治疗相关的并发症，并讨论了这种方法的优缺点。
在六个月期间（2008 - 2009年），我们进行了22例游离皮瓣手术。大多数（17例）患者患有口腔癌。其中7例与舌部有关，8例与颊黏膜有关。桡侧前臂游离皮瓣（RFF：9例）和股前外侧皮瓣（ALT：9例）是最常用的皮瓣。1例腓骨皮瓣用于下颌骨前部缺损，1例空肠游离皮瓣用于喉咽切除术缺损。有6例并发症，进行了2次再次手术，但未出现皮瓣丢失。
在资源有限的情况下，通过积极的态度和精心规划，微血管游离皮瓣重建是可行的。
