Chung Jae-Ho, Kim Ki-Jae, Jung Kwang-Yoon, Baek Seung-Kuk, Park Seung-Ha, Yoon Eul-Sik
Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Anam Hospital, Seoul, Korea.
Arch Craniofac Surg. 2020 Oct;21(5):269-275. doi: 10.7181/acfs.2020.00339. Epub 2020 Oct 20.
The advance in microsurgical technique has facilitated a proper approach for reconstruction of extensive head and neck defects. For the success of free tissue reconstruction, selection of the recipient vessel is one of the most important factors. However, the vascular anatomy of this region is very complex, and a clear guideline about this subject is still lacking. In this study, we present our 30 years of experiences of free tissue reconstruction for head and neck defects.
In this retrospective study, we analyzed a total of 138 flaps in 127 patients who underwent head and neck reconstruction using free tissue transfer following tumor resection between October 1986 to August 2019. Patients who underwent facial palsy reconstruction were excluded. Medical records including patient's demographics, detailed operation notes, follow-up records, and photographs were collected and analyzed.
Among a total of 127 patients, 10 patients underwent a secondary operation due to cancer recurrence. The most commonly used type of flap was radial forearm flap (n= 107), followed by the anterolateral thigh flap (n= 18) and fibula flap (n= 10). With regard to recipient vessels, superior thyroid artery was most commonly used in arterial anastomosis (58.7%), and internal jugular vein (51.3%) was the first choice for venous anastomosis. The flap survival rate was 100%. Four cases of venous thrombosis were resolved with thrombectomy and re-anastomosis.
Superior thyroid artery and internal jugular vein were reliable choices as recipient vessels. Proper recipient vessel selection could improve the result of head and neck reconstruction.
显微外科技术的进步为广泛头颈部缺损的重建提供了合适的方法。对于游离组织重建的成功而言，受区血管的选择是最重要的因素之一。然而，该区域的血管解剖结构非常复杂，关于这一主题仍缺乏明确的指导原则。在本研究中，我们介绍了我们30年来对头颈部缺损进行游离组织重建的经验。
在这项回顾性研究中，我们分析了1986年10月至2019年8月期间127例接受肿瘤切除术后采用游离组织移植进行头颈部重建的患者中的138个皮瓣。排除接受面神经麻痹重建的患者。收集并分析包括患者人口统计学资料、详细手术记录、随访记录和照片在内的病历。
在总共127例患者中，10例因癌症复发接受了二次手术。最常用的皮瓣类型是桡侧前臂皮瓣（n = 107），其次是股前外侧皮瓣（n = 18）和腓骨皮瓣（n = 10）。关于受区血管，甲状腺上动脉最常用于动脉吻合（58.7%），颈内静脉（51.3%）是静脉吻合的首选。皮瓣存活率为100%。4例静脉血栓形成通过血栓切除术和重新吻合得到解决。
甲状腺上动脉和颈内静脉是可靠的受区血管选择。正确选择受区血管可以改善头颈部重建的效果。
