Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
Division of Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
JAMA Otolaryngol Head Neck Surg. 2020 Jun 1;146(6):537-542. doi: 10.1001/jamaoto.2020.0160.
The fibula free flap donor site is associated with both short-term and long-term morbidity. Split-thickness skin graft (STSG) loss can lead to long delays in donor site healing and is associated with significant adverse sequelae. Patients may experience initial good STSG uptake after bolster removal but may have subsequent partial or total loss related to contact pressure or shearing.
To determine if increased duration of bolster use is associated with increased STSG uptake rates following fibula free flap reconstruction.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients 18 years and older undergoing fibula free flap reconstruction following head and neck extirpative surgery at a tertiary care academic medical center from May 2013 to March 2019. The donor sites were photographed 4 weeks postoperatively, and areas of graft uptake were measured using image processing software. The baseline demographic, comorbidity, and operative characteristics were also collected.
A fine mesh gauze with 3% bismuth tribromophenate and petrolatum blend bolster was sutured over leg STSGs placed on fibula free flap donor sites intraoperatively, and the ankle and lower leg were immobilized for 5 days in a plaster splint. Bolsters were either removed on postoperative day 5 or 14. Thereafter, the STSGs were covered with a petroleum and bismuth gauze and a cotton dressing.
Rates of donor site infection and STSG percentage uptake at 4 weeks.
Of the 42 included patients, 31 (74%) were male, and the mean (SD) age was 62.1 (13.1) years. A total of 20 patients were included in the 5-day group, and 22 were included in the 14-day group. The 14-day bolster group had a higher mean percentage skin graft uptake rate compared with the 5-day bolster duration group (77.5% vs 59.9%), with an effect size of -0.632 (95% CI, -1.260 to -0.004). Patients with Adult Comorbidity Evalution-27 scores of 3 had poorer rates of STSG uptake compared with patients with Adult Comorbidity Evalution-27 scores of 0 to 2 (65.9% vs 82.9%), with an effect size of 0.599 (95% CI, -0.191 to 1.389). No donor site infections were noted in either group.
Fourteen-day bolster application to the fibula free flap donor site was associated with better STSG uptake rates than 5-day bolster application.
腓骨游离皮瓣供区与短期和长期发病率有关。部分厚度皮片（STSG）丢失可导致供区愈合延迟，并伴有显著的不良后果。患者在去除支撑物后可能会经历初始的良好 STSG 吸收，但可能会因接触压力或剪切力而随后发生部分或全部丢失。
确定延长支撑物使用时间是否与游离腓骨皮瓣重建后头颈部根治性手术后腓骨游离皮瓣供区的 STSG 吸收率增加有关。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 2013 年 5 月至 2019 年 3 月在三级学术医疗中心接受游离腓骨皮瓣重建的 18 岁及以上头颈部根治性手术患者。术后 4 周对供区进行拍照，并使用图像处理软件测量移植物吸收率。还收集了基线人口统计学、合并症和手术特征。
术中将带有 3%三溴甲酚铋和凡士林混合物的细网纱布固定在腓骨游离皮瓣供区的腿部 STSG 上，踝关节和小腿用石膏夹板固定 5 天。支撑物要么在术后第 5 天，要么在第 14 天去除。此后，将 STSG 用石油和铋纱布和棉敷料覆盖。
供区感染和 STSG 吸收率在 4 周时的发生率。
在纳入的 42 名患者中，31 名（74%）为男性，平均（SD）年龄为 62.1（13.1）岁。20 名患者被纳入 5 天组，22 名患者被纳入 14 天组。14 天支撑组的皮肤移植物吸收率明显高于 5 天支撑组（77.5%比 59.9%），效应量为-0.632（95%CI，-1.260 至-0.004）。成人合并症评估-27 评分 3 分的患者与成人合并症评估-27 评分 0 至 2 分的患者相比，STSGS 吸收率较差（65.9%比 82.9%），效应量为 0.599（95%CI，-0.191 至 1.389）。两组均未发生供区感染。
腓骨游离皮瓣供区应用 14 天支撑物与 5 天支撑物应用相比，可提高 STSG 吸收率。
