Beederman Maureen, Jaffe Jennifer, Kuchta Kristine, Warner Jeremy
From the Section of Plastic and Reconstructive Surgery, The University of Chicago Medicine, Chicago, IL.
Department of Surgery.
Ann Plast Surg. 2021 Mar 1;86(3):287-291. doi: 10.1097/SAP.0000000000002478.
Forehead flaps are one of the workhorse flaps for nasal reconstruction, especially for large defects involving the nasal tip, ala, or multiple nasal subunits. Forehead flaps are often performed on older patients who have accompanying comorbidities and who may be at higher risk for anesthetic complications. The aim of this retrospective study was to compare the safety and success of forehead flap nasal reconstruction in 2 different clinical settings: those performed under local anesthesia in an office-based procedure room, compared with those performed in the operating room under either general anesthesia or intravenous sedation.
A retrospective chart review was performed on all patients who underwent forehead flap reconstruction between the years of 2011 and 2018 by the senior author. Patient demographics, operative details, and postoperative complications were recorded and analyzed. Patients were followed for 1 year postoperatively or until the end of the study period. Patients were excluded if they had an accompanying unrelated cosmetic procedures performed during first-stage forehead flap reconstruction.
A total of 96 forehead flaps were performed, 35 of which (36.5%) were done in an office-based procedure room using local anesthesia only. Patient ages ranged from 45 to 92 years, with an average age of 71.9 years. The majority of flaps (n = 81, 85.3%) were divided at the second-stage procedure. There was no statistically significant difference in time elapsed between first- and second-stage procedures between groups (procedure room: 22.6 days; operating room: 23.8 days). There were 13 total postoperative complications (13.5%), but there was no statistically significant difference in complication rate between groups (office-based: 3 complications, 8.6%; operating room: 10 complications, 16.4%).
Our data suggest that forehead flap reconstruction can be done safely with acceptable postoperative results when performed under local anesthesia in an office-based outpatient setting.
额部皮瓣是鼻再造的常用皮瓣之一，尤其适用于鼻尖、鼻翼或多个鼻亚单位的大面积缺损。额部皮瓣手术常用于伴有合并症、麻醉并发症风险较高的老年患者。本回顾性研究的目的是比较在两种不同临床环境下进行额部皮瓣鼻再造的安全性和成功率：在门诊手术室内进行的局部麻醉手术，与在手术室进行的全身麻醉或静脉镇静手术。
对2011年至2018年间由资深作者进行额部皮瓣再造的所有患者进行回顾性病历审查。记录并分析患者的人口统计学资料、手术细节和术后并发症。术后对患者进行1年随访或直至研究期结束。如果患者在一期额部皮瓣再造期间同时进行了无关的美容手术，则将其排除。
共进行了96例额部皮瓣手术，其中35例（36.5%）仅在门诊手术室内使用局部麻醉完成。患者年龄在45岁至92岁之间，平均年龄为71.9岁。大多数皮瓣（n = 81，85.3%）在二期手术时进行分割。两组一期和二期手术之间的时间间隔无统计学差异（手术间：22.6天；手术室：23.8天）。术后共有13例并发症（13.5%），但两组并发症发生率无统计学差异（门诊：3例并发症，8.6%；手术室：10例并发症，16.4%）。
我们的数据表明，在门诊局部麻醉下进行额部皮瓣再造可以安全完成，术后效果可接受。
