Xu Zhong-fei, Duan Wei-yi, Zhang En-jiao, Bai Shuang, Tian Yu, Tan Xue-xin, Liu Fa-yu, Sun Chang-fu
Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
Department of Oral Maxillofacial Surgery, School of Stomatology, China Medical University, No.117, Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, People's Republic of China.
World J Surg Oncol. 2015 May 14;13:183. doi: 10.1186/s12957-015-0576-8.
The purpose of this study was to investigate the reliability and outcome of using the transverse cervical vessel (TCV) as a recipient vessel for microvascular reconstruction in patients whose vessels in the neck region are unavailable because of previous surgery or radiotherapy.
Between January 2012 and August 2014, secondary head and neck reconstruction was performed using the TCV as a recipient vessel in eight patients who had undergone previous neck dissection and radiation therapy (n = 5). Five patients had a recurrent carcinoma, one had undergone an operation for scar release and two had been treated surgically for a second primary cancer. The anterolateral thigh flap (ALT), anteromedial thigh flap (AMT), and fibular flap were used for the reconstruction. Clinical data were recorded for each patient.
All of the ipsilateral transverse cervical arteries were found to be free of disease. The second free flap was revascularized using the TCVs (n = 6) or the external (n = 1) or internal (n = 1) jugular vein. The free flaps used for the reconstruction included the ALT flap (n = 6), AMT flap (n = 2), and fibular flap (n = 1). All of the flaps survived without vascular events, and the patients healed without major complications. The mean follow-up time was 11 months. One patient died of distant metastases during follow-up.
In patients who have previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and easily accessible recipient vessels for microsurgical reconstruction in the oral and maxillofacial region. If the transverse cervical vein is unavailable, the internal or external jugular vein should be dissected carefully to serve as an alternative for microvascular anastomoses.
本研究的目的是调查对于因既往手术或放疗导致颈部区域血管不可用的患者，使用颈横血管（TCV）作为微血管重建受区血管的可靠性和效果。
在2012年1月至2014年8月期间，对8例既往接受过颈部清扫术和放射治疗（n = 5）的患者，使用颈横血管作为受区血管进行二期头颈重建。5例患者患有复发性癌，1例接受了瘢痕松解手术，2例接受了第二原发癌的手术治疗。使用股前外侧皮瓣（ALT）、股前内侧皮瓣（AMT）和腓骨皮瓣进行重建。记录每位患者的临床数据。
所有同侧颈横动脉均未发现病变。第二个游离皮瓣通过颈横血管（n = 6）或颈外静脉（n = 1）或颈内静脉（n = 1）进行血管再通。用于重建的游离皮瓣包括ALT皮瓣（n = 6）、AMT皮瓣（n = 2）和腓骨皮瓣（n = 1）。所有皮瓣均存活，未发生血管事件，患者愈合良好，无重大并发症。平均随访时间为11个月。1例患者在随访期间死于远处转移。
对于既往接受过颈部手术（无论是否接受放疗）的患者，颈横血管是口腔颌面部显微外科重建中可靠且易于获取的受区血管。如果颈横静脉不可用，应仔细解剖颈内或颈外静脉作为微血管吻合的替代选择。
