Welz Christian, Canis Martin, Schwenk-Zieger Sabina, Spiegel Jennifer L, Weiss Bernhard G, Pilavakis Yiannis
Assistant Medical Director and Senior Physician, Department of Otorhinolaryngology, Head and Neck Surgery, Georg August University, Goettingen, Germany.
Professor and Head, Department of Otorhinolaryngology, Head and Neck Surgery, Georg August University, Goettingen, Germany.
J Oral Maxillofac Surg. 2017 Oct;75(10):2261-2269. doi: 10.1016/j.joms.2017.02.017. Epub 2017 Mar 2.
To evaluate whether the pedicled supraclavicular artery island flap (SCAIF) is a sufficient alternative to the fasciocutaneous radial forearm free flap (RFFF) for oral reconstruction in cancer surgery.
The authors designed and implemented a retrospective cohort study composed of all consecutive patients who underwent head and neck reconstruction after cancer surgery at their tertiary university hospital from 2013 to 2016. Demographics and peri- and postoperative information were recorded and statistically analyzed.
Of 83 patients who underwent head and neck reconstruction after cancer, 50 were identified as having stage III or IV squamous cell carcinoma of the oral cavity and oropharynx and underwent surgery and reconstruction with the SCAIF (n = 25) or the RFFF (n = 25). Total surgery time (411.0 vs 576.4 minutes; P < .001), flap elevation time (39.00 vs 93.78 minutes; P < .001), need for intensive care observation (32 vs 96%; P < .05), and rate of tracheotomy (64 vs 88%; P < .05) were significantly lower in the SCAIF group. There was no statistical difference in the postoperative complication rate or postoperative functional swallowing ability between the 2 groups. Total perioperative costs were significantly lower in patients who underwent reconstruction with the SCAIF (2,621.15 vs 4,453.77€; P < .01).
The results of this study suggest that the SCAIF is a straightforward and reliable flap with shorter operative times and comparable outcomes compared with the RFFF.
评估带蒂锁骨上动脉岛状皮瓣（SCAIF）是否足以替代桡侧前臂游离筋膜皮瓣（RFFF）用于癌症手术中的口腔重建。
作者设计并实施了一项回顾性队列研究，该研究纳入了2013年至2016年在其三级大学医院接受癌症手术后头颈部重建的所有连续患者。记录了人口统计学以及围手术期和术后信息，并进行了统计分析。
在83例接受癌症手术后头颈部重建的患者中，50例被确定患有口腔和口咽的III期或IV期鳞状细胞癌，并接受了SCAIF（n = 25）或RFFF（n = 25）手术及重建。SCAIF组的总手术时间（411.0对576.4分钟；P <.001）、皮瓣掀起时间（39.00对93.78分钟；P <.001）、重症监护观察需求（32%对96%；P <.05）以及气管切开率（64%对88%；P <.05）均显著更低。两组之间的术后并发症发生率或术后功能性吞咽能力无统计学差异。接受SCAIF重建的患者围手术期总费用显著更低（2,621.15对4,453.77欧元；P <.01）。
本研究结果表明，与RFFF相比，SCAIF是一种操作简单且可靠的皮瓣，手术时间更短，结果相当。
