Kim SeongRyoung, Lee Dong-Hun, Ahn Kang-Min
Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505 Korea.
Maxillofac Plast Reconstr Surg. 2020 Aug 26;42(1):29. doi: 10.1186/s40902-020-00273-4. eCollection 2020 Dec.
Microvascular reconstruction is the treatment of choice after oral cancer ablation surgery. There are few published studies of free flap survival among Korean populations. This study aimed to determine the survival rate after 121 consecutive cases of maxillofacial microvascular reconstruction and to analyze the complications associated with microsurgery.
This study included consecutive patients who underwent microsurgical reconstruction with free flaps, from January 2006 through September 2019, performed by a single surgeon at the oral and maxillofacial surgery department of a tertiary medical center. A total of 121 cases were reviewed retrospectively. The flap survival rate, flap type, radiotherapy history, complications, and treatment results were analyzed.
Four different flap types were used for microvascular reconstruction: radial forearm ( = 65), fibula ( = 34), latissimus dorsi ( = 21), and serratus anterior muscle with rib bone free flap ( = 1). Total necrosis of the flap was found in four cases (two latissimus dorsi flaps and two fibular flaps). The free flap survival rate was 97.5%. Nineteen patients received radiotherapy before surgery, and none of them experienced flap failure. The mean operation time was 334 ± 83.1 min, and the mean ischemic time was 48.9 ± 12.7 min.
The success rate was reliable and comparable with previous studies. The success rate was not affected by radiation therapy. Free flaps can be safely used even after radiation treatment.
微血管重建是口腔癌切除术后的首选治疗方法。关于韩国人群中游离皮瓣存活情况的已发表研究较少。本研究旨在确定121例连续的颌面微血管重建术后的存活率，并分析与显微外科手术相关的并发症。
本研究纳入了2006年1月至2019年9月在一家三级医疗中心口腔颌面外科由一名外科医生进行游离皮瓣显微外科重建的连续患者。共对121例病例进行回顾性分析。分析皮瓣存活率、皮瓣类型、放疗史、并发症及治疗结果。
微血管重建使用了四种不同的皮瓣类型：桡侧前臂皮瓣（n = 65）、腓骨皮瓣（n = 34）、背阔肌皮瓣（n = 21）和带肋骨的前锯肌游离皮瓣（n = 1）。发现4例皮瓣完全坏死（2例背阔肌皮瓣和2例腓骨皮瓣）。游离皮瓣存活率为97.5%。19例患者术前接受了放疗，且均未出现皮瓣失败。平均手术时间为334 ± 83.1分钟，平均缺血时间为48.9 ± 12.7分钟。
成功率可靠，与先前研究相当。成功率不受放疗影响。即使在放疗后也可安全使用游离皮瓣。
