Marttila E, Thorén H, Törnwall J, Viitikko A, Wilkman T
Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, PO Box 220, FI-00029 Helsinki, Finland.
Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, FI-20520 Turku, Finland; Department of Oral and Maxillofacial Diseases, Turku University Hospital, Lemminkäisenkatu 2, FI-20520 Turku, Finland.
Br J Oral Maxillofac Surg. 2018 Nov;56(9):835-840. doi: 10.1016/j.bjoms.2018.09.005. Epub 2018 Oct 15.
The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005-2010. The patients' clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n=86, 45%) and the anterolateral thigh free flap (ALTFF) (n=48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n=25, 13%). There were postoperative complications that required intervention in a quarter of the patients, most often in the age group 41-50 years (p=0.018). Older age was not associated with the development of complications. The overall survival of all free flaps was 181/191 (95%), and the only significant individual predictor of loss of a flap was reconstruction with a DCIA (p=0.016), five of the 25 of which were lost. We conclude therefore that DCIA free flaps are associated with an increased risk of failure; the method of osseous reconstruction for maxillofacial reconstruction should be selected carefully; and carefully chosen older patients do not seem to be at increased risk of morbidity.
这项回顾性研究的目的是分析2005年至2010年这五年间我院191例口腔癌一期重建术后皮瓣并发症及皮瓣丢失的发生率。记录了患者的临床和个人详细信息、肿瘤特征、微血管皮瓣类型、并发症及治疗结果。最常用的软组织皮瓣是桡侧前臂游离筋膜皮瓣（RFFF）（n = 86，45%）和股前外侧游离皮瓣（ALTFF）（n = 48，25%），而最常用的骨皮瓣是旋髂深动脉皮瓣（DCIA）（n = 25，13%）。四分之一的患者出现了需要干预的术后并发症，最常出现在41 - 50岁年龄组（p = 0.018）。年龄较大与并发症的发生无关。所有游离皮瓣的总体存活率为181/191（95%），皮瓣丢失的唯一显著个体预测因素是采用DCIA进行重建（p = 0.016），25例中有5例皮瓣丢失。因此，我们得出结论，DCIA游离皮瓣失败风险增加；颌面重建的骨重建方法应谨慎选择；精心挑选的老年患者发病风险似乎并未增加。
