促进头颈部重建中股前外侧皮瓣供区一期缝合的手术算法方法。
Surgical Algorithmic Approach to Facilitate Primary Closure of the Anterolateral Thigh Flap Donor Site in Head and Neck Reconstruction.
作者信息
Hung Kuo-Shu, Chen Szu-Han, Chen Wei-Chen, Tseng Wan-Ling, Lee Yao-Chou
机构信息
From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan; and †Department of Plastic and Reconstructive Surgery, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan.
出版信息
Ann Plast Surg. 2019 Jan;82(1S Suppl 1):S33-S38. doi: 10.1097/SAP.0000000000001729.
BACKGROUND
Use of the anterolateral thigh (ALT) flap has gained popularity in head and neck reconstruction. However, donor sites that cannot achieve primary closure are reported to have poorer functional and aesthetic outcomes. Therefore, we propose an algorithm to facilitate primary closure of the donor site.
METHODS
Since May 2013, when an attempt at donor site direct closure failed, we have used a VY advancement flap or a propeller flap for primary closure of the donor site, using the remnant lateral thigh perforator or nearby medial thigh perforator. Otherwise, a skin graft was used. A total of 91 patients were enrolled in this algorithmic approach. We retrospectively reviewed patients with head and neck cancer who underwent cancer ablation and immediate ALT flap reconstruction since August 2010. The patients were then categorized into a "before" group and an "after" group according to the application time of the algorithm. Their demographics, intraoperative findings, and postoperative outcomes were analyzed.
RESULTS
A total of 321 patients (309 men, 12 women) were enrolled, with 230 patients in the before group and 91 patients in the after group, with a mean age of 52.9 years. The mean size of the flap was 130 cm, with a mean width of 8.1 cm. No statistical difference existed between the groups. The donor site was directly closed in 82 patients (35.7%) in the before group. Using the perforator-based flap in 21 patients (23.1%), the donor site was closed primarily in 72 patients (79.1%) in the after group, contributing to a significantly higher donor site closure rate (P < 0.001). The average operative time was 348.7 minutes. The overall flap survival rate was 97.2%, donor-site complication rate was 6.9%, and hospitalization length was 23.5 days. None showed statistical differences between the groups.
CONCLUSIONS
The proposed algorithm may considerably increase the primary closure rate of the ALT flap donor site.
背景
股前外侧（ALT）皮瓣在头颈部重建中的应用日益广泛。然而，据报道，无法实现一期缝合的供区功能和美学效果较差。因此，我们提出一种算法以促进供区的一期缝合。
方法
自2013年5月起，当供区直接缝合尝试失败时，我们使用V-Y推进皮瓣或推进皮瓣，利用残留的大腿外侧穿支或附近的大腿内侧穿支对供区进行一期缝合。否则，使用皮肤移植。共有91例患者采用了这种算法方法。我们回顾性分析了2010年8月以来接受癌症切除并立即进行ALT皮瓣重建的头颈癌患者。然后根据算法的应用时间将患者分为“术前”组和“术后”组。分析了他们的人口统计学特征、术中发现和术后结果。
结果
共纳入321例患者（309例男性，12例女性），术前组230例，术后组91例，平均年龄52.9岁。皮瓣平均大小为130平方厘米，平均宽度为8.1厘米。两组之间无统计学差异。术前组82例患者（35.7%）供区直接缝合。术后组21例患者（23.1%）使用穿支皮瓣，72例患者（79.1%）供区一期缝合，供区缝合率显著更高（P < 0.001）。平均手术时间为348.7分钟。皮瓣总体成活率为97.2%，供区并发症发生率为6.9%，住院时间为23.5天。两组之间均无统计学差异。
结论
所提出的算法可能会显著提高ALT皮瓣供区的一期缝合率。
Zotero 插件