Sun Alexander Haosi, Xu Xiaolu, Sasaki Clarence Takashi, Ariyan Stephan, Steinbacher Derek Matthew
*Section of Plastic and Reconstructive Surgery †Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT.
J Craniofac Surg. 2017 Jul;28(5):1354-1361. doi: 10.1097/SCS.0000000000003591.
Head and neck (HN) defects after tumor extirpation can be challenging to repair. Historically, pedicled flaps were the mainstay for reconstruction, but recently, free tissue transfer has been preferred. This study compares patient characteristics and flap outcomes for HN defects over a 30-year period at the authors' institution.
Head and neck cancer patients receiving flap reconstruction from 1983 to 2013 were included. Records were reviewed for demographic and perioperative data. Flap complications were compared and statistical tests were 2-tailed with a significance level of 0.05.
Eight hundred sixty-one patients fulfilled inclusion and exclusion criteria. Pedicled reconstruction predominated during early time-points (96.3% pedicled), compared with later years (69.5% free-tissue). Free flaps were associated with significantly longer operative times (643.5 versus 429.7 minutes, P<0.0001) and postoperative stays (16.89 versus 14.01 nights, P = 0.0005) and had higher rates of emergent reoperation, total flap loss, hematoma, and donor site morbidity. Previous irradiation did not affect major complication rate for either flap type.
A shift from pedicled to free flaps for HN reconstruction occurred over the last 30 years. Free flaps had a higher complication profile in this cohort, which was largely accounted for by a higher return rate to the operating room compared with pedicled flaps (17.31% versus 5.46%, P<0.0001). Additionally, this complication profile may reflect the increasingly common use of free tissue flaps for more complex reconstructions. Several of these differences in complication rates between flap types were no longer significant in the last 5 years of this study.
肿瘤切除术后的头颈部（HN）缺损修复具有挑战性。从历史上看，带蒂皮瓣是重建的主要手段，但最近，游离组织移植更受青睐。本研究比较了作者所在机构30年间HN缺损患者的特征及皮瓣治疗结果。
纳入1983年至2013年接受皮瓣重建的头颈部癌症患者。回顾记录以获取人口统计学和围手术期数据。比较皮瓣并发症，并采用双侧统计检验，显著性水平为0.05。
861例患者符合纳入和排除标准。在早期，带蒂重建占主导（96.3%为带蒂），而在后期（69.5%为游离组织）。游离皮瓣的手术时间显著更长（643.5分钟对429.7分钟，P<0.0001），术后住院时间也更长（16.89晚对14.01晚。P = 0.0005），且急诊再次手术、皮瓣完全坏死、血肿及供区并发症发生率更高。既往放疗对两种皮瓣类型的主要并发症发生率均无影响。
在过去30年中，HN重建从带蒂皮瓣转向了游离皮瓣。在该队列中，游离皮瓣的并发症更多，这在很大程度上是因为与带蒂皮瓣相比，其返回手术室的比率更高（17.31%对5.46%，P<0.0001）。此外，这种并发症情况可能反映了游离组织皮瓣越来越多地用于更复杂的重建。在本研究的最后5年中，皮瓣类型之间的几种并发症发生率差异不再显著。
