Reiter M, Harréus U, Kisser U, Betz C S, Baumeister Ph
Department of Otolaryngology and Head and Neck Surgery, Grosshadern Clinic, Ludwig Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.
Department of Otolaryngology and Head and Neck Surgery, Evangelisches Krankenhaus, Duesseldorf, Germany.
Eur Arch Otorhinolaryngol. 2017 Jan;274(1):427-430. doi: 10.1007/s00405-016-4214-z. Epub 2016 Jul 16.
Thrombosis of the pedicle is central to free flap failure, and early revision of a compromised flap is the key to successfully salvage a flap. Therefore, the majority of free flaps in reconstructive head and neck surgery are used with the ability to visually examine the flap. Sometimes, due to intra-operative circumstances, it is necessary to use a flap that cannot be monitored externally. These flaps are called buried flaps and have the reputation of being put at risk. The current literature provides only limited data to support or disprove this position. A single institution retrospective review of patient charts between 2007 and 2015 was performed. Flap monitoring was carried out with hand-held Doppler of the pedicle hourly for the first 72 h in all cases. Additional duplex ultrasound was performed in the majority of buried flaps. A total of 437 flaps were included into the study. 37 flaps (7.8 %) were identified to fulfill the criteria of a buried free flap. In total, four patients had complications, three of which required operative reexploration. All interventions were successful, resulting in no flap loss in our series. An accurate operation technique combined with meticulous monitoring protocols supported by duplex ultrasound can result in satisfactory outcome of buried flaps. No enhanced risk of flap loss of buried flaps was found in our cohort.
蒂部血栓形成是游离皮瓣失败的核心因素，对出现问题的皮瓣尽早进行修复是成功挽救皮瓣的关键。因此，在头颈部重建手术中，大多数游离皮瓣在使用时具备可视检查皮瓣的能力。有时，由于术中情况，有必要使用无法进行外部监测的皮瓣。这些皮瓣被称为埋藏皮瓣，且素有风险较高的名声。目前的文献仅提供了有限的数据来支持或反驳这一观点。我们对2007年至2015年间的患者病历进行了单机构回顾性研究。所有病例在术后72小时内每小时用手持式多普勒仪对蒂部进行皮瓣监测。大多数埋藏皮瓣还进行了双功超声检查。本研究共纳入437例皮瓣。其中37例（7.8%）被确定符合埋藏游离皮瓣的标准。共有4例患者出现并发症，其中3例需要再次手术探查。所有干预均获成功，我们系列研究中无皮瓣丢失情况。精确的手术技术结合双功超声支持的细致监测方案可使埋藏皮瓣获得满意疗效。在我们的队列研究中未发现埋藏皮瓣皮瓣丢失风险增加。
