Kushida-Contreras Beatriz Hatsue, Manrique Oscar J, Gaxiola-García Miguel Angel
Plastic and Reconstructive Surgery Department, Mexico's General Hospital (Hospital General de México), Mexico City, Mexico.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, NY, USA.
Ann Surg Oncol. 2021 May;28(5):2882-2895. doi: 10.1245/s10434-021-09590-y. Epub 2021 Feb 6.
Damage of the vascular system secondary to radical neck dissection and/or radiotherapy or other treatments has a negative impact on microsurgical reconstruction. The search for adequate recipient vessels is hindered by the complexity of previous procedures.
A systematic review of microsurgical head and neck reconstruction in the vessel-depleted neck was performed. The issues analyzed were indications for surgery, more frequently performed flaps, vascular systems used as recipient vessels, outcomes, and complications.
The eligibility criteria were fulfilled by 57 studies published between September 1993 and January 2020. In 8235 patients, 8694 flaps were performed, 925 of which were for a vessel-depleted neck. The most commonly used flap was the anterolateral thigh flap, used in 195 cases (30%), followed by the radial forearm free flap, used in 157 cases (24%). The potential recipient vessels were numerous for arteries (26 options) and veins (31 options). For the 712 flaps with an identifiable recipient artery, the superficial temporal artery was the most commonly used vessel (n = 142, 20%). The superficial temporal vein was the most commonly used vessel for 639 flaps with an identifiable recipient vein (n = 118, 18.5%). Complications amounted to 11%; 80 out of 716 flaps in papers that reported them. Flap losses were reported in 2% of cases.
Major microsurgical head and neck reconstruction for postoncologic defects depends on appropriate recipient vessels. Vein availability is paramount. Understanding the complexity of this problem is useful for preoperative planning, precise decision-making, and an accurate surgical approach.
根治性颈清扫术和/或放疗或其他治疗继发的血管系统损伤对显微外科重建有负面影响。先前手术的复杂性阻碍了对合适受区血管的寻找。
对血管缺失型颈部的显微外科头颈重建进行了系统评价。分析的问题包括手术指征、更常使用的皮瓣、用作受区血管的血管系统、结果和并发症。
1993年9月至2020年1月发表的57项研究符合纳入标准。8235例患者共进行了8694例皮瓣移植，其中925例用于血管缺失型颈部。最常用的皮瓣是股前外侧皮瓣，195例（30%），其次是游离桡侧前臂皮瓣，157例（24%）。动脉的潜在受区血管有多种选择（26种），静脉也有多种选择（31种）。对于712例可识别受区动脉的皮瓣，颞浅动脉是最常用的血管（n = 142，20%）。对于639例可识别受区静脉的皮瓣，颞浅静脉是最常用的血管（n = 118，18.5%）。并发症发生率为11%；报告并发症的论文中，716例皮瓣中有80例发生并发症。皮瓣坏死率报告为2%。
肿瘤切除术后缺损的大型显微外科头颈重建取决于合适的受区血管。静脉的可利用性至关重要。了解该问题的复杂性有助于术前规划、精确决策和准确的手术入路。
