Department of Surgery, Division of Otolaryngology, QEII Health Sciences Centre, Faculty of Medicine, Dalhousie University, Suite 3044 - Dickson Building, 5820 University Avenue, Halifax B3H 1 V7 NS, Canada.
J Otolaryngol Head Neck Surg. 2014 Jan 13;43(1):1. doi: 10.1186/1916-0216-43-1.
To assess the functional donor site morbidity of the forearm free flap in patients surviving at least 2 years after ablative head and neck cancer surgery in a tertiary care centre.
This study involved nine long-term survivors (2 year post-operative) who had forearm free flaps to reconstruct head and neck defects. All flaps were raised from the non-dominant arm. The non-donor side acted as a control for all patients. Objective measurements were as follows: grip, tip pinch and key pinch strength measured with dynamometers; flexion, extension, radial and ulnar deviation and pronation and supination range of motion at the wrist measured with goniometry; A timed manual dexterity task was performed with a grooved pegboard test, and sensation of the radial nerve was tested with Semmes Weinstein monofilaments. Subjective measurements included a validated patient questionnaire of hand function and opinions of scar appearance as well as a validated scar assessment from two different observers.
Pronation at the wrist, manual dexterity and sensation were found to be significantly reduced in the donor side compared to the non-donor side. Inter-rater agreement between the two observers was found to be poor, except for an acceptable correlation between overall scar opinions. No correlations were found between any subjective or objective items or between the patient's and the observers' subjective evaluations.
Donor site morbidity can be demonstrated with objective testing however this is accepted and well tolerated by head and neck cancer patients.
评估在三级护理中心接受头颈部癌症消融术后至少 2 年的患者前臂游离皮瓣的功能供区发病率。
本研究纳入了 9 名长期生存（术后 2 年）的前臂游离皮瓣头颈部缺损重建患者。所有皮瓣均由非优势臂提起。非供区作为所有患者的对照。客观测量如下：使用测力计测量握力、指尖捏力和关键捏力；使用量角器测量腕关节的屈伸、桡侧和尺侧偏斜以及旋前和旋后活动度；使用带槽钉板测试进行定时手动灵巧度任务，使用 Semmes-Weinstein 单丝测试桡神经感觉。主观测量包括手部功能的验证患者问卷、疤痕外观的意见以及来自两位不同观察者的验证疤痕评估。
与非供区相比，供区腕关节旋前、手灵巧度和感觉明显降低。两位观察者之间的组内相关性除了总体疤痕意见之间的可接受相关性外，相关性较差。任何主观或客观项目之间或患者和观察者的主观评估之间均未发现相关性。
虽然可以通过客观测试来证明供区发病率，但头颈部癌症患者能够接受并很好地耐受。
