口腔癌所致头颈部缺损的多次游离皮瓣重建术
Multiple Free Flap Reconstructions of Head and Neck Defects Due to Oral Cancer.
作者信息
Mochizuki Yumi, Harada Hiroyuki, Shimamoto Hiroaki, Tomioka Hirofumi, Hirai Hideaki
机构信息
Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
Plast Reconstr Surg Glob Open. 2017 Jun 13;5(6):e1337. doi: 10.1097/GOX.0000000000001337. eCollection 2017 Jun.
OBJECTIVE
We studied complications following multiple free flap reconstructions in the head and neck.
METHODS
In this cohort, 26 patients (14 men and 12 women) who underwent multiple microvascular free flap reconstructions were included in the study. The reasons for secondary reconstruction were recurrence of tumor (12 cases), necrosis of transferred skin and/or bone (6 cases), reconstruction plate fracture or exposure (4 cases), and others (4 cases). A third reconstruction in 4 cases and a fourth reconstruction in 1 case were performed.
RESULTS
No flap necrosis occurred. Postsurgical infections occurred at only secondary reconstructions in 7 patients. Although 4 cases with a history of external radiation therapy were anastomosed at contralateral side, those 4 cases suffered from severe pre-and postsurgical infection of the ipsilateral side. Postsurgical infection occurred in 2 cases with anastomoses at the ipsilateral side of the neck and required drainage after secondary surgery.
CONCLUSIONS
A history of external radiation therapy and the existence of severe preoperative infection affected complications after multiple reconstructions.
目的
我们研究了头颈部多次游离皮瓣重建术后的并发症。
方法
本队列研究纳入了26例行多次微血管游离皮瓣重建术的患者（14例男性，12例女性）。二次重建的原因包括肿瘤复发（12例）、移植皮肤和/或骨坏死（6例）、重建钢板骨折或外露（4例）以及其他原因（4例）。4例行第三次重建，1例行第四次重建。
结果
未发生皮瓣坏死。仅7例患者在二次重建时发生术后感染。尽管4例有外照射治疗史的患者在对侧进行吻合，但这4例患者同侧术前和术后均发生严重感染。2例在颈部同侧进行吻合的患者发生术后感染，二次手术后需要引流。
结论
外照射治疗史和术前存在严重感染影响多次重建后的并发症。
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