Fanzio Paolo Maria, Chang Kai-Ping, Chen Hsin-Hung, Hsu Hsiang-Hao, Gorantla Vijay, Solari Mario G, Kao Huang-Kai
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
Ann Surg Oncol. 2015 Sep;22(9):3055-60. doi: 10.1245/s10434-014-4322-1. Epub 2015 Jan 7.
This study aimed to identify the risk factors for postoperative plate exposure in head and neck cancer patients with composite mandibular defects undergoing tumor ablation followed by bridging plate and anterolateral thigh (ALT) flap transfer.
Between January 2007 and June 2012, 1,452 patients who underwent free tissue transfer after head and neck cancer ablation were retrospectively reviewed. Only ALT flap coverage with a bridging plate for segmental mandibular defects was included. The Jewer's classification was used to define the type of mandibular defect.
The study enrolled 123 men and 7 women. The incidence of plate exposure was 37.7 % (49/130). The follow-up time ranged from 0.5 to 5.4 years (mean, 2.4 years). The 5-year probability of a plate exposure-free rate was 32.8 % for the patients with postoperative radiotherapy (RT) (n = 33) and 64.3 % for the patients without it (n = 97). Patients reconstructed with a fasciocutaneous or chimeric type of ALT flap had higher rates of plate exposure than those reconstructed with a musculocutaneous type of ALT flap (p = 0.002). As shown by logistic regression, the significant predictive risk factors for postoperative plate exposure still were postoperative RT [adjusted odds ratio (OR) 2.76, 95 % confidence interval (CI) 1.09-6.99, p = 0.031] and intraoperative blood loss (adjusted OR 2.37, 95 % CI 1.13-4.99, p = 0.022).
The type of ALT flap, postoperative RT, and intraoperative blood loss were the predisposing factors for increased risk of postoperative plate exposure in the specific disease group.
本研究旨在确定接受肿瘤切除、桥接钢板植入及股前外侧（ALT）皮瓣移植修复下颌骨复合缺损的头颈癌患者术后钢板外露的危险因素。
回顾性分析2007年1月至2012年6月期间1452例头颈癌切除术后接受游离组织移植的患者。仅纳入采用桥接钢板联合ALT皮瓣修复节段性下颌骨缺损的病例。采用朱厄尔分类法定义下颌骨缺损类型。
本研究共纳入123例男性和7例女性。钢板外露发生率为37.7%（49/130）。随访时间为0.5至5.4年（平均2.4年）。术后接受放疗（RT）的患者（n = 33）5年无钢板外露率为32.8%，未接受放疗的患者（n = 97）为64.3%。采用筋膜皮瓣或嵌合型ALT皮瓣修复的患者钢板外露率高于采用肌皮型ALT皮瓣修复的患者（p = 0.002）。逻辑回归分析显示，术后钢板外露的显著预测危险因素仍为术后放疗[调整优势比（OR）2.76，95%置信区间（CI）1.09 - 6.99，p = 0.031]和术中失血（调整OR 2.37，95%CI 1.13 - 4.99，p = 0.022）。
在特定疾病组中，ALT皮瓣类型、术后放疗和术中失血是术后钢板外露风险增加的诱发因素。
