Wolfer S, Wohlrath R, Kunzler A, Foos T, Ernst C, Schultze-Mosgau S
Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
Department of Oral and Maxillofacial & Plastic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
Br J Oral Maxillofac Surg. 2020 May;58(4):451-457. doi: 10.1016/j.bjoms.2020.02.020. Epub 2020 Mar 19.
Microsurgical procedures for reconstruction after resection of head and neck tumours have become standardised and reliable. Among them, the scapular free flap is used less often, mostly to avoid excessive operating times. We hypothesise that complex reconstructions after resection of oral squamous cell carcinoma (OSCC) are successful even with time-consuming free flaps such as the scapular free flap. In this retrospective, single-centre study, we used the evaluation of medical records to investigate the postoperative outcome of microvascular reconstruction after ablative surgery of OSCC. Associations among the categorical variables were analysed using Pearson's chi squared test or Fisher's exact test. Among the continuous variables, the t test or Mann-Whitney U test were used as appropriate. For multivariate analysis, the logistic regression model was calculated. In the sample of 280 free flap reconstructions, we performed 142 radial forearm and 119 scapular free flaps. The American Society of Anesthesiology (ASA) score (p=0.006) and the duration of the operation (p=0.010) are independent factors which influence the need for operative revisions. The type of free flap is irrelevant for that. With 4.2% flap losses, scapular free flaps were successful; even in patients ≥ 70 years old (0 flap losses). Complex reconstructions after surgical resection of OSCC are successful even in aged patients. The scapular free flap is a good choice for mandibular reconstruction despite the time-consuming intraoperative repositioning of the patient. In an increasingly ageing group of patients, who have more vascular diseases, scapular free flaps could be a very successful alternative after ablative surgery of oral squamous cell carcinoma.
头颈部肿瘤切除术后的显微外科重建手术已变得标准化且可靠。其中，肩胛游离皮瓣的使用频率较低，主要是为了避免手术时间过长。我们推测，即使使用耗时的游离皮瓣（如肩胛游离皮瓣），口腔鳞状细胞癌（OSCC）切除术后的复杂重建手术仍能成功。在这项回顾性单中心研究中，我们通过病历评估来调查OSCC切除术后微血管重建的术后结果。分类变量之间的关联采用Pearson卡方检验或Fisher精确检验进行分析。对于连续变量，根据情况使用t检验或Mann-Whitney U检验。进行多变量分析时，计算逻辑回归模型。在280例游离皮瓣重建样本中，我们进行了142例桡侧前臂游离皮瓣和119例肩胛游离皮瓣手术。美国麻醉医师协会（ASA）评分（p = 0.006）和手术持续时间（p = 0.010）是影响手术翻修需求的独立因素。游离皮瓣的类型对此并无影响。肩胛游离皮瓣的成功率为4.2%；即使在70岁及以上患者中（皮瓣无损失）也是如此。OSCC手术切除后的复杂重建手术即使在老年患者中也能成功。尽管术中患者重新定位耗时，但肩胛游离皮瓣仍是下颌骨重建的良好选择。在血管疾病较多的老年患者群体中，肩胛游离皮瓣可能是口腔鳞状细胞癌切除术后非常成功的替代方案。
