Garg Ravi K, Poore Samuel O, Wieland Aaron M, Mcculloch Timothy M, Hartig Gregory K
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
Microsurgery. 2015 Nov;35(8):591-5. doi: 10.1002/micr.22506. Epub 2015 Sep 30.
Elective free flap revision among head and neck cancer patients remains poorly characterized. This study evaluates patients who underwent flap revision and their surgical outcomes. Patients who underwent tumor extirpation with free flap reconstruction were identified over a 5-year period. Elective flap revision was defined as debulking or redraping of the original free flap for functional or cosmetic reasons. Patient demographics, surgical indications, and outcomes were reviewed. One hundred and eighty-six patients were identified, and 19 (10.2%) underwent flap revision. Revision of oral cavity flaps (n = 9, 47.4%) was performed to address excessive flap bulk compromising lip competence, speech, swallowing, mastication, or placement of a dental prosthesis. Revision of flaps resurfacing the face or neck (n = 10, 52.6%) was performed to address facial ptosis after facial nerve sacrifice, facial asymmetry, or soft tissue redundancy. Revisions were performed at an average of 7.3 months postoperatively and there was no age or gender bias toward undergoing flap revision. Patients whose flap skin paddles were used to resurface the facial or neck skin were significantly more likely to undergo elective revision than patients with an external paddle designed for flap monitoring (p < 0.01). We identified a 10% elective revision rate for head and neck free flaps in cancer patients, approximately half of which were performed to improve oral cavity function and half of which were performed to address facial ptosis or asymmetry. While there was no age or gender preference for flap revision, extensive facial or neck resurfacing was significantly associated with eventual flap revision.
头颈部癌症患者的择期游离皮瓣修复情况仍缺乏充分描述。本研究评估了接受皮瓣修复的患者及其手术结果。在5年期间确定了接受游离皮瓣重建肿瘤切除的患者。择期皮瓣修复定义为因功能或美容原因对原始游离皮瓣进行减容或重新塑形。回顾了患者的人口统计学资料、手术指征和结果。共确定了186例患者，其中19例（10.2%）接受了皮瓣修复。对口腔皮瓣进行修复（n = 9，47.4%）是为了解决皮瓣体积过大影响唇部功能、言语、吞咽、咀嚼或牙修复体放置的问题。对面部或颈部进行皮瓣修复（n = 10，52.6%）是为了解决面神经牺牲后的面部下垂、面部不对称或软组织冗余问题。修复平均在术后7.3个月进行，接受皮瓣修复不存在年龄或性别偏向。皮瓣皮肤瓣用于面部或颈部皮肤重建的患者比设计用于皮瓣监测的外置瓣患者更有可能接受择期修复（p < 0.01）。我们确定癌症患者头颈部游离皮瓣的择期修复率为10%，其中约一半是为了改善口腔功能，另一半是为了解决面部下垂或不对称问题。虽然皮瓣修复没有年龄或性别偏好，但广泛的面部或颈部重建与最终的皮瓣修复显著相关。
