Lai Hsin-Ti, Kuo Pao-Jen, Chang Chih-Hau, Lai Chung-Sheng, Lin Sin-Daw, Kuo Yur-Ren
Ann Plast Surg. 2018 Feb;80(2S Suppl 1):S36-S39. doi: 10.1097/SAP.0000000000001302.
Bulky appearance after free flap reconstruction in patients with head and neck cancer is common and requires revision to achieve improved final outcomes. Although different delayed debulking methods have been reported, the procedure can be technically difficult in patients with severe scaring after adjuvant radiotherapy. The present study proposes a combined method of liposuction and arthroscopic shaving for delayed contouring of free flaps in head and neck reconstruction.
In this study, 12 patients with head and neck cancer who had bulky flaps after cancer ablation surgery and immediate free anterolateral thigh flap reconstruction were included. These patients underwent delayed debulking through the combined arthroscopic shaving and liposuction method at least 3 months after the initial reconstruction or the completion of adjuvant radiotherapy (if required). Age, sex, cancer stages, the presence or absence of adjuvant radiotherapy, the interval between the initial free flap reconstruction and the debulking procedure, complications, and subjective satisfaction ratings were recorded 1 and 6 months after the revision surgery.
All patients were men, with an average age of 56.3 years (43-69 years), and 9 (75%) patients underwent adjuvant radiotherapy. Partial flap loss was not observed in the study patients, and subjective satisfaction ratings improved after the debulking procedure.
The combined liposuction and arthroscopic shaving method can facilitate the debulking and contouring procedures in patients with head and neck cancer after free flap reconstruction. With appropriate timing, the combined procedure can be simple and safe, even in patients with severe scaring after adjuvant radiotherapy.
头颈癌患者游离皮瓣重建后外观臃肿很常见，需要进行修复以获得更好的最终效果。尽管已报道了不同的延迟减容方法，但对于辅助放疗后有严重瘢痕的患者，该手术在技术上可能具有挑战性。本研究提出一种吸脂与关节镜下削切相结合的方法，用于头颈重建中游离皮瓣的延迟塑形。
本研究纳入了12例头颈癌患者，这些患者在癌症切除手术及即刻游离股前外侧皮瓣重建后皮瓣臃肿。这些患者在初次重建后或辅助放疗（如有需要）完成后至少3个月，通过关节镜下削切与吸脂相结合的方法进行延迟减容。记录翻修手术后1个月和6个月时的年龄、性别、癌症分期、是否接受辅助放疗、初次游离皮瓣重建与减容手术之间的间隔、并发症及主观满意度评分。
所有患者均为男性，平均年龄56.3岁（43 - 69岁），9例（75%）患者接受了辅助放疗。研究患者未观察到部分皮瓣丢失，减容手术后主观满意度评分有所提高。
吸脂与关节镜下削切相结合的方法可促进头颈癌患者游离皮瓣重建后的减容和塑形手术。在合适的时机，即使是辅助放疗后有严重瘢痕的患者，该联合手术也可简单且安全。
