Myers Larry L, Ahn Chul
Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Professor, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX.
J Oral Maxillofac Surg. 2014 Sep;72(9):1832-40. doi: 10.1016/j.joms.2014.03.003. Epub 2014 Mar 13.
There are few studies analyzing the long-term clinical effects related to increasing the size of head and neck free tissue reconstructions. The purpose of this study was to compare long-term clinical outcomes of patients undergoing very large area (≥200 cm(2)) and large area (100 to 199 cm(2)) free tissue reconstructions of head and neck defects.
Institutional review board approval was obtained before conducting this retrospective cohort study at the authors' university-based tertiary care hospitals. The authors analyzed the charts of consecutive patients with free flaps of at least 100 cm(2) treated from July 2000 to December 2011. Very large area flaps were arbitrarily defined as larger than 200 cm(2). Intraoperative variables, flap success rates, overall survival, and total hospital and intensive care unit (ICU) stays for the 2 groups were analyzed. Fisher exact tests or χ(2) tests were used for categorical variables and Student t tests were used for continuous variables. Log-rank tests were conducted to investigate whether overall survival was significantly different between the 2 groups. Statistical significance was defined as a P value less than .05.
The charts of 121 consecutive patients were analyzed. Thirty-eight patients (31%) had very large area flaps (277.1 ± 79.4 cm(2); range, 200 to 576 cm(2)) and 83 patients (69%) had large area flaps (140.1 ± 25.5 cm(2)). There was no difference between flap groups in presenting T4 stage disease (P = .448). Ninety-eight percent of the very large area flaps and 93% of the large area flaps survived. Total hospital stays for the very large area and large area flap groups were 12.8 ± 8.2 and 12.3 ± 8.3 days, respectively (P = not significant). In contrast, ICU stays were increased for the very large area flap group at 7.1 ± 7.5 versus 4.0 ± 4.0 days for the large area flap group (P = .022). The overall median patient survival for the very large area flap group was 7.6 months (95% confidence interval, 5.7-10.0) and that for the large area flap group was 8.4 months (95% confidence interval, 5.4-12.9; P = .376).
Performing very large area flaps for head and neck reconstruction did not negatively affect clinical outcome. Comparable success rates, total hospital stays, and overall survival can be safely achieved in this difficult patient population. More studies need to be conducted on resource usage.
分析增加头颈部游离组织重建面积所带来的长期临床效果的研究较少。本研究的目的是比较接受大面积（≥200 cm²）和较大面积（100至199 cm²）头颈部缺损游离组织重建患者的长期临床结局。
在作者所在的大学三级医疗中心进行这项回顾性队列研究之前，已获得机构审查委员会的批准。作者分析了2000年7月至2011年12月期间接受至少100 cm²游离皮瓣治疗的连续患者的病历。大面积皮瓣被任意定义为大于200 cm²。分析了两组的术中变量、皮瓣成功率、总生存率以及总住院时间和重症监护病房（ICU）住院时间。分类变量采用Fisher精确检验或χ²检验，连续变量采用Student t检验。进行对数秩检验以调查两组之间的总生存率是否存在显著差异。统计学显著性定义为P值小于0.05。
分析了121例连续患者的病历。38例患者（31%）接受了大面积皮瓣（277.1±79.4 cm²；范围为200至576 cm²），83例患者（69%）接受了较大面积皮瓣（140.1±25.5 cm²）。皮瓣组在出现T4期疾病方面无差异（P = 0.448）。98%的大面积皮瓣和93%的较大面积皮瓣存活。大面积皮瓣组和较大面积皮瓣组的总住院时间分别为12.8±8.2天和12.3±8.3天（P = 无显著性差异）。相比之下，大面积皮瓣组的ICU住院时间增加至7.1±7.5天，而较大面积皮瓣组为4.0±4.0天（P = 0.022）。大面积皮瓣组患者的总体中位生存期为7.6个月（95%置信区间，5.7 - 10.0），较大面积皮瓣组为8.4个月（95%置信区间，5.4 - 12.9；P = 0.376）。
进行大面积头颈部重建皮瓣对临床结局没有负面影响。在这一困难的患者群体中，可以安全地实现相当的成功率、总住院时间和总生存率。需要对资源使用进行更多研究。
