Li Jun, Shen Yi, Wang Liang, Wang Jin-Bing, Sun Jian, Haugen Thorsen W
Associate Professor, Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
Associate Professor, Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
J Oral Maxillofac Surg. 2018 Aug;76(8):1786-1793. doi: 10.1016/j.joms.2018.02.008. Epub 2018 Feb 20.
The aims of this study are to review our surgical experience in maxillary and midface reconstruction using free vascularized tissue and to compare the postoperative outcomes based on superficial temporal versus cervical recipient vessels.
We performed a retrospective review of patients who underwent maxillary and midface reconstruction with free vascularized tissue from March 2001 to July 2014. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels and those in whom cervical vessels were used as the recipient vessels. Patient gender and age, cause and classification of the defect, flap choice for reconstruction, recipient vessels, postoperative course, and complications also were recorded and analyzed. A 2-tailed Fisher exact test was used to compare outcomes between the 2 groups.
On the basis of the different recipient vessels, 94 patients were divided into 2 groups: those with superficial temporal recipient vessels (n = 44) and those with cervical recipient vessels (n = 50). The overall flap survival rate was 99.0%. The overall complication rate for vascular anastomoses was 5.3%. The complication rate in patients with cervical recipient vessels was higher than the complication rate in those with superficial temporal recipient vessels (8.0% vs 2.27%, P = .37). In addition, in patients in the group with superficial temporal recipient vessels, the postoperative scar in the pre-tragal region was rated as more satisfactory than the postsurgical scar in those in the cervical recipient vessel group.
We recommend that the superficial temporal vessels be the first option for recipient vessels in free vascularized tissue maxillary and midface reconstruction because of proximity, superficial positioning, and suitability for anastomosis and monitoring and because these vessels are rarely compromised by prior operations or radiotherapy.
本研究旨在回顾我们使用游离带血管组织进行上颌骨及面中部重建的手术经验，并比较基于颞浅血管与颈血管作为受区血管的术后效果。
我们对2001年3月至2014年7月期间接受游离带血管组织上颌骨及面中部重建的患者进行了回顾性研究。分析了两组患者：一组使用颞浅血管作为受区血管，另一组使用颈血管作为受区血管。记录并分析了患者的性别、年龄、缺损的原因及分类、重建所用的皮瓣选择、受区血管、术后病程及并发症。采用双侧Fisher精确检验比较两组的结果。
根据不同的受区血管，94例患者被分为两组：颞浅受区血管组（n = 44）和颈受区血管组（n = 50）。皮瓣总体成活率为99.0%。血管吻合的总体并发症发生率为5.3%。颈受区血管组患者的并发症发生率高于颞浅受区血管组患者（8.0%对2.27%，P = 0.37）。此外，在颞浅受区血管组患者中，耳屏前区域的术后瘢痕被评为比颈受区血管组患者的手术瘢痕更令人满意。
我们建议，在游离带血管组织上颌骨及面中部重建中，颞浅血管应作为受区血管的首选，因为其位置接近、表浅，适合吻合及监测，且这些血管很少因既往手术或放疗而受损。
