Lodders J N, Schulten E A J M, de Visscher J G A M, Forouzanfar T, Karagozoglu K H
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
J Reconstr Microsurg. 2016 Jul;32(6):455-63. doi: 10.1055/s-0036-1571794. Epub 2016 Feb 5.
Background We retrospectively analyzed the incidence and types of postoperative complications after mandibular continuity reconstructions with fibular free flaps (FFF) in patients with oral squamous cell carcinoma (OSCC) and identified potential risk factors for postoperative complications. Methods Data were retrieved from the medical records in the Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands from April 1995 to September 2013, and were statistically analyzed. Results In this study, 85 patients were included in whom 86 FFFs were used for mandibular reconstruction. Thirty-seven patients (43%) developed ≥ 1 surgical complication and 9 patients (10.5%) developed ≥ 1 systemic complication. Three patients (3.5%) developed total flap failure and six patients (7.0%) developed partial flap failure. Surgical complications were correlated with tobacco use, partial glossectomy, type of mandibular defect, and anatomic staging. Systemic complications were associated with age > 60 years and Charlson comorbidity index > 2. Hospitalization > 30 days was associated with type of mandibular defect. Conclusions The use of the FFF for reconstructing mandibular continuity defects in OSCC patients may be associated with postoperative complications. Patients with coexisting medical conditions and anterior mandibular defects have an increased risk for developing complications. Patients who undergo segmental mandibular resection including a partial glossectomy could have a reduced risk for complications.
背景 我们回顾性分析了口腔鳞状细胞癌（OSCC）患者采用游离腓骨瓣（FFF）进行下颌骨连续性重建术后并发症的发生率及类型，并确定了术后并发症的潜在风险因素。方法 从荷兰阿姆斯特丹VU大学医学中心/阿姆斯特丹牙科学术中心（ACTA）口腔颌面外科/口腔病理学系1995年4月至2013年9月的病历中提取数据，并进行统计学分析。结果 本研究纳入85例患者，其中86个游离腓骨瓣用于下颌骨重建。37例患者（43%）发生≥1种手术并发症，9例患者（10.5%）发生≥1种全身并发症。3例患者（3.5%）出现皮瓣完全坏死，6例患者（7.0%）出现皮瓣部分坏死。手术并发症与吸烟、部分舌切除术、下颌骨缺损类型及解剖分期相关。全身并发症与年龄>60岁及查尔森合并症指数>2有关。住院时间>30天与下颌骨缺损类型有关。结论 在OSCC患者中使用游离腓骨瓣重建下颌骨连续性缺损可能与术后并发症有关。合并内科疾病及下颌骨前部缺损的患者发生并发症的风险增加。接受包括部分舌切除术在内的下颌骨节段性切除的患者并发症风险可能降低。
