Ban Myung Jin, Na Gina, Ko Sungchul, Kim Joohyun, Heo Nam Hun, Choi Eun Chang, Park Jae Hong, Kim Won Shik
Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea.
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2021 Nov;14(4):407-413. doi: 10.21053/ceo.2020.00234. Epub 2020 Sep 10.
To compare the surgical outcomes of externally monitored and conventional buried flaps with the goal of determining the usefulness of external monitoring of buried flaps.
In this case-control study with propensity score matching, 30 patients were evenly divided into externally monitored buried flap and conventional buried flap groups. The total operative time for free flap reconstruction, the flap survival rate, the length of hospital stay, the initial time of a reliable visual assessment, complications, the final diet achieved, and the duration until diet initiation were compared between the groups.
The mean operative time for reconstruction was 115 minutes (interquartile range, 85-150 minutes) and 142 minutes (interquartile range, 95-180 minutes) in the externally monitored and conventional groups, respectively (P= 0.245). The median length of hospital stay was 24 days (interquartile range, 18-30 days) and 27 days (interquartile range, 20-41 days) in the externally monitored and conventional groups, respectively (P=0.298). The median duration until diet initiation was 15 days (interquartile range, 15-21 days) and 18 days (interquartile range, 15-34 days) in the externally monitored and conventional groups, respectively (P=0.466). The final diet, initial time of a reliable visual assessment, and complications were comparable between the groups, but the external skin paddle provided an excellent visual assessment immediately postoperatively in all cases.
The outcomes were comparable between the groups, indicating that externalization of the cutaneous component of a buried flap may be a straightforward and useful technique for monitoring a buried anterolateral thigh free flap in laryngopharyngeal reconstructions. The salvage and false-positive rates of compromised flaps should be compared in large subject groups in future studies to prove that the use of an external skin paddle improves flap monitoring.
比较外部监测皮瓣和传统埋入式皮瓣的手术效果，以确定外部监测埋入式皮瓣的实用性。
在这项倾向评分匹配的病例对照研究中，30例患者被平均分为外部监测埋入式皮瓣组和传统埋入式皮瓣组。比较两组间游离皮瓣重建的总手术时间、皮瓣存活率、住院时间、可靠视觉评估的初始时间、并发症、最终达到的饮食情况以及开始进食的持续时间。
外部监测组和传统组重建的平均手术时间分别为115分钟（四分位间距，85 - 150分钟）和142分钟（四分位间距，95 - 180分钟）（P = 0.245）。外部监测组和传统组的中位住院时间分别为24天（四分位间距，18 - 30天）和27天（四分位间距，20 - 41天）（P = 0.298）。外部监测组和传统组开始进食的中位持续时间分别为15天（四分位间距，15 - 21天）和18天（四分位间距，15 - 34天）（P = 0.466）。两组间最终饮食、可靠视觉评估的初始时间和并发症相当，但外部皮瓣在所有病例术后即刻提供了良好的视觉评估。
两组间结果相当，表明埋入式皮瓣皮肤成分的外置化可能是一种用于喉咽重建中监测埋入式股前外侧游离皮瓣的直接且有用的技术。未来研究应在大样本组中比较受损皮瓣的挽救率和假阳性率，以证明使用外部皮瓣可改善皮瓣监测。
