Maldonado Andrés A, Silva Amanda K, Humphries Laura S, Gottlieb Lawrence J
Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
J Reconstr Microsurg. 2017 May;33(4):233-243. doi: 10.1055/s-0036-1597656. Epub 2017 Jan 5.
Ablation of locally advanced or recurrent head and neck cancer often results in large composite orofacial defects with limited recipient vessels. These complex defects lend well to intrinsic chimeric flap reconstruction, which allows greater ability to inset various flap component tissue types than composite flaps and requires only one set of microvascular anastomoses. A retrospective chart review was performed on all patients who underwent orofacial reconstruction with an intrinsic chimeric free flap from 2002 to 2015. Flaps with only one tissue type, such as two separate skin paddles with no additional component, were not considered chimeric flaps and therefore not included in this report. Patient demographic data, defect, and flap characteristics, as well as complications and outcomes were analyzed to create a guide for flap selection. Univariate and multivariate analysis was performed to determine risk factors for flap take-back and failure. Seventy-five patients underwent orofacial intrinsic chimeric free flap reconstruction. Results were organized based on defect characteristics to create a guide for flap selection. The number of chimeric flap components and operation duration were independently statistically associated with flap take-backs ( < 0.05). There were two (3%) total and five (7%) partial flap losses. Average follow-up time was 32.7 months. Intrinsic chimeric flaps provide a versatile and elegant reconstructive option for a variety of complex orofacial defects. We provide a guide to facilitate decision making in flap selection for these challenging reconstructions and report factors associated with flap take-backs and losses.
局部晚期或复发性头颈癌的消融术常常导致大面积复合性口面部缺损，且受区血管有限。这些复杂的缺损很适合采用自体嵌合皮瓣重建，与复合皮瓣相比，自体嵌合皮瓣能够更灵活地植入各种皮瓣组成组织类型，并且仅需进行一组微血管吻合。对2002年至2015年期间所有接受自体嵌合游离皮瓣进行口面部重建的患者进行了回顾性病历审查。仅包含一种组织类型的皮瓣，如两个独立的皮瓣且无其他组成部分，不被视为嵌合皮瓣，因此未纳入本报告。分析患者的人口统计学数据、缺损情况、皮瓣特征以及并发症和治疗结果，以制定皮瓣选择指南。进行单因素和多因素分析以确定皮瓣回植和失败的危险因素。75例患者接受了口面部自体嵌合游离皮瓣重建。根据缺损特征整理结果，以制定皮瓣选择指南。嵌合皮瓣的组成部分数量和手术持续时间与皮瓣回植独立相关（<0.05）。共有2例（3%）皮瓣完全丢失，5例（7%）部分丢失。平均随访时间为32.7个月。自体嵌合皮瓣为各种复杂的口面部缺损提供了一种通用且出色的重建选择。我们提供了一份指南，以促进在这些具有挑战性的重建中进行皮瓣选择决策，并报告与皮瓣回植和丢失相关的因素。
