Kent Sean Lloyd, Kim Yohanan, Perez Hector, Frank Ethan, Gentry Vance, LaTour Donn, Inman Jared
Department of Otolaryngology, Loma Linda University, Loma Linda, California.
Facial Plast Surg. 2020 Dec;36(6):768-772. doi: 10.1055/s-0040-1721811. Epub 2020 Dec 24.
Reconstruction of head and neck surgical defects can be a complicated, costly process. While the era of cost-effective medicine has begun to broadly question the necessity of high-cost care, times of extraordinary sociomedical demand bring increased scrutiny to even routine costs and resource utilization. Within this context, we reviewed the advantages, drawbacks, and financial costs of both regional and free flap reconstructions, namely the decreased costs and hospital resource utilization that may be associated with reconstruction using regional flaps. Although beset by reports of partial necrosis in certain regional flaps-particularly the submental island, cervicofacial advancement, and supraclavicular artery island flaps-many reports have demonstrated complication and flap failure rates equivalent to those of free flaps. Additionally, regional flaps have been associated with decreased costs for hospital stay, most notably in cases of postoperative complications. In cases necessitating free flap reconstruction, cost-savings strategies such as bypassing postoperative intensive care unit admissions have been shown to provide satisfactory, safe outcomes. As the head and neck surgeon continues to adapt to the medical pressures of a global pandemic, resource-sparing approaches to oncologic care will persist in their newfound importance.
头颈部手术缺损的重建可能是一个复杂且成本高昂的过程。虽然具有成本效益的医学时代已开始广泛质疑高成本医疗的必要性，但在社会医疗需求极高的时期，即使是常规成本和资源利用也会受到更多审视。在此背景下，我们回顾了局部皮瓣和游离皮瓣重建的优点、缺点及财务成本，即使用局部皮瓣重建可能带来的成本降低和医院资源利用减少。尽管某些局部皮瓣（特别是颏下岛状皮瓣、颈面部推进皮瓣和锁骨上动脉岛状皮瓣）存在部分坏死的报道，但许多报告显示其并发症和皮瓣失败率与游离皮瓣相当。此外，局部皮瓣与住院成本降低有关，在术后并发症的情况下尤为明显。在需要游离皮瓣重建的病例中，诸如绕过术后重症监护病房住院等节省成本的策略已被证明能提供令人满意的安全结果。随着头颈外科医生继续适应全球大流行带来的医疗压力，肿瘤治疗中节约资源的方法将持续保持其新凸显的重要性。
