Kucur Cuneyt, Durmus Kasim, Uysal Ismail O, Old Matthew, Agrawal Amit, Arshad Hassan, Teknos Theodoros N, Ozer Enver
Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 320 W 10th Ave. B216 Starling Loving Hall, Columbus, OH, 43210, USA.
Department of Otolaryngology Head and Neck Surgery, University of Dumlupinar, Kutahya, Turkey.
Eur Arch Otorhinolaryngol. 2016 Jan;273(1):209-13. doi: 10.1007/s00405-014-3489-1. Epub 2015 Jan 10.
Microvascular free flaps are preferred for most major head and neck reconstruction surgeries because of better functional outcomes, improved esthetics, and generally higher success rates. Numerous studies have investigated measures to prevent flap loss, but few have evaluated the optimal treatment for free flap complications. This study aimed to determine the complication rate after free flap reconstructions and discusses our management strategies. Medical records of 260 consecutive patients who underwent free flap reconstructions for head and neck defects between July 2006 and June 2010 were retrospectively reviewed for patient and surgical characteristics and postoperative complications. The results revealed that microvascular free flaps were extremely reliable, with a 3.5 % incidence of flap failure. There were 78 surgical site complications. The most common complication was neck wound infection, followed by dehiscence, vascular congestion, abscess, flap necrosis, hematoma, osteoradionecrosis, and brisk bleeding. Twenty patients with poor wound healing received hyperbaric oxygen therapy, which was ineffective in three patients who eventually experienced complete flap loss. Eleven patients with vascular congestion underwent medicinal leech therapy, which was effective. Among the 78 patients with complications, 44 required repeat surgery, which was performed for postoperative brisk bleeding in three. Eventually, ten patients experienced partial flap loss and nine experienced complete flap loss, with the latter requiring subsequent pectoralis major flap reconstruction. Microvascular free flap reconstruction represents an essential and reliable technique for head and neck defects and allows surgeons to perform radical resection with satisfactory functional results and acceptable complication rates.
由于功能效果更好、美观度提高且总体成功率更高，微血管游离皮瓣在大多数主要的头颈部重建手术中更受青睐。众多研究探讨了预防皮瓣坏死的措施，但很少有研究评估游离皮瓣并发症的最佳治疗方法。本研究旨在确定游离皮瓣重建术后的并发症发生率，并讨论我们的处理策略。回顾性分析了2006年7月至2010年6月期间连续260例行游离皮瓣重建术治疗头颈部缺损患者的病历，以了解患者和手术特征以及术后并发症情况。结果显示，微血管游离皮瓣非常可靠，皮瓣坏死发生率为3.5%。有78例手术部位并发症。最常见的并发症是颈部伤口感染，其次是裂开、血管充血、脓肿、皮瓣坏死、血肿、放射性骨坏死和出血活跃。20例伤口愈合不良的患者接受了高压氧治疗，其中3例无效，最终皮瓣完全坏死。11例血管充血患者接受了水蛭疗法，效果良好。在78例有并发症的患者中，44例需要再次手术，其中3例因术后出血活跃而进行了再次手术。最终，10例患者出现部分皮瓣坏死，9例患者出现完全皮瓣坏死，后者随后需要行胸大肌皮瓣重建术。微血管游离皮瓣重建是头颈部缺损的一项重要且可靠的技术，使外科医生能够进行根治性切除，获得满意的功能效果和可接受的并发症发生率。
