Sharaf Basel, Xue Amy, Solari Mario G, Boa Olivier, Liu Jun, Hanasono Matthew M, Skoracki Roman, Yu Peirong, Selber Jesse C
Rochester, Minn.; Houston, Texas; Pittsburgh, Pa.; Lévis, Quebec, Canada; and Columbus, Ohio.
From the Division of Plastic Surgery, Mayo Clinic; the Division of Plastic Surgery, Baylor College of Medicine; the Department of Plastic Surgery, University of Pittsburgh; Hôtel-Dieu de Lévis; the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, The Ohio State University.
Plast Reconstr Surg. 2017 Jan;139(1):105e-119e. doi: 10.1097/PRS.0000000000002915.
Pharyngoesophageal reconstruction is a complex endeavor that poses many challenges. This 10-year series examines factors impacting the need for neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes.
A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a local flap, or a second free flap. All groups were compared by comorbidities, complications, and functional outcomes.
Of 294 patients, 179 (60.9 percent) required neck skin resurfacing. In the resurfaced group, there were 90 circumferential defects (50.3 percent) and 89 partial defects (49.7 percent). In the resurfaced group, 110 (61.4 percent) underwent reconstruction with a second skin paddle from the same free flap pedicle, 21 (11.7 percent) underwent reconstruction with a muscle component from the same pedicle, and 25 (13.9 percent) received a pectoralis major flap. There were five external paddle flap losses in the resurfaced group (2.8 percent) and no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula rate (4.5 percent) compared with the primary closure group (11.3 percent) (p = 0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (p < 0.001).
Neck resurfacing is often required in salvage pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neoconduit is predictive of lower pharyngocutaneous fistula rates. An algorithmic approach to neck resurfacing is presented.
咽食管重建是一项复杂的工作，面临诸多挑战。本项为期10年的研究系列探讨了影响颈部皮肤表面修复需求的因素，并评估了重建方式对治疗结果的影响。
回顾性分析确定了2002年至2012年间接受咽食管重建的294例患者。根据颈部皮肤表面修复需求对患者进行分组。接受颈部修复的患者进一步细分为重建技术组，包括来自同一游离皮瓣蒂的第二个皮瓣或肌肉成分、局部皮瓣或第二个游离皮瓣。对所有组的合并症、并发症和功能结果进行比较。
294例患者中，179例（60.9%）需要颈部皮肤表面修复。在修复组中，有90例环形缺损（50.3%）和89例部分缺损（49.7%）。在修复组中，110例（61.4%）采用来自同一游离皮瓣蒂的第二个皮瓣进行重建，21例（11.7%）采用来自同一蒂的肌肉成分进行重建，25例（13.9%）接受胸大肌皮瓣。修复组有5例外部皮瓣丢失（2.8%），无内部皮瓣丢失。各组总体并发症相似。与一期缝合组（11.3%）相比，修复组咽皮肤瘘发生率较低（4.5%）（p = 0.026）。既往颈部手术和放疗是颈部皮肤表面修复的有力预测因素（p < 0.001）。
挽救性咽食管重建中常需要进行颈部修复。在新建管道上提供额外的带血管组织可预测较低的咽皮肤瘘发生率。本文提出了一种颈部修复的算法方法。
