From the Division of Plastic and Reconstructive Surgery, Mayo Clinic. Rochester, MN.
Department of Plastic and Reconstructive Surgery, China Medical University, Hospital. Taichung, Taiwan.
Ann Plast Surg. 2020 Jan;84(1):68-72. doi: 10.1097/SAP.0000000000001953.
Management after total pharyngolaryngectomy with free ileocolon flaps can be challenging. Adequate postoperative surgical guidelines are essential to avoid complications. Factors, such as agitation, hypotension, or prolonged mechanical ventilation, might compromise final outcomes. Herein, we describe our experience in the early postoperative care of patients after total pharyngolaryngectomy with immediate reconstruction using the free ileocolon flap.
This is a retrospective review of all patients who underwent total pharyngolaryngectomy and immediate reconstruction using the free Ileocolon flap. Demographics, etiology of resection, neoadjuvant therapy, surgical time, method of sedation, postoperative use of vasopressors, length of intensive care unit (ICU) stay, time of discontinuation of mechanical ventilation, and complications were recorded and analyzed.
Between 2010 and 2015, a total of 34 patients underwent total pharyngolaryngectomy and immediate reconstruction using the free Ileocolon flap. The most common cause of total pharyngolaryngectomy was cancer. Twenty-eight patients had neoadjuvant therapy (radiation). The average surgical time was 11.5 hours (range, 8-14.5 hours), average length of ICU stay was 3 days (range, 2-15 days) with an average time for mechanical ventilation cessation of 3 days (range, 1-20 days). Midazolam and dexmedetomidine were the most common sedatives used during surgery and in the ICU period. Three patients required vasopressors due to hypotension, 2 had unplanned self-extubation from the tracheostomy site, 2 experienced postoperative bleeding, 1 had pneumonia, 4 required unplanned return to the operating room, 2 had partial flap loss, and 1 had complete flap loss.
Overall, a majority of patients recovered well postoperatively with minimal complications and low rate of reoperation. Our research provides a foundation to develop a risk-stratified approach to determine the need for an ICU admission or early transfer to floor care.
全咽喉切除术并游离回肠结肠瓣重建后的管理具有挑战性。为避免并发症，制定充分的术后手术指南至关重要。躁动、低血压或机械通气时间延长等因素可能会影响最终结果。在此，我们描述了我们在全咽喉切除术并立即使用游离回肠结肠瓣重建后的患者的早期术后护理经验。
这是对所有接受全咽喉切除术并立即使用游离回肠结肠瓣重建的患者进行的回顾性研究。记录并分析了患者的人口统计学资料、切除病因、新辅助治疗、手术时间、镇静方法、术后血管加压素使用、重症监护病房（ICU）停留时间、机械通气停止时间和并发症。
2010 年至 2015 年期间，共有 34 例患者接受了全咽喉切除术并立即使用游离回肠结肠瓣重建。全咽喉切除术最常见的原因是癌症。28 例患者接受了新辅助治疗（放疗）。平均手术时间为 11.5 小时（8-14.5 小时），平均 ICU 住院时间为 3 天（2-15 天），机械通气停止时间平均为 3 天（1-20 天）。咪达唑仑和右美托咪定是手术和 ICU 期间最常用的镇静剂。由于低血压，有 3 例患者需要血管加压素，2 例患者在气管造口部位计划外自行拔管，2 例患者发生术后出血，1 例患者发生肺炎，4 例患者需要计划外返回手术室，2 例患者出现部分瓣坏死，1 例患者出现完全瓣坏死。
总体而言，大多数患者术后恢复良好，并发症少，再次手术率低。我们的研究为制定风险分层方法以确定是否需要入住 ICU 或早期转入病房护理提供了基础。
