Vieira Luís, Isacson Daniel, Dimovska Eleonora O F, Rodriguez-Lorenzo Andres
Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Plast Reconstr Surg Glob Open. 2021 Jan 22;9(1):e3329. doi: 10.1097/GOX.0000000000003329. eCollection 2021 Jan.
Free flap reconstruction in the head and neck region is a complex field in which patient comorbidities, radiation therapy, tumor recurrence, and variability of clinical scenarios make some cases particularly challenging and prone to devastating complications. Despite low free flap failure rates, the impact of flap failure has enormous consequences for the patients.
Acknowledging and predicting high risk intra- and postoperative situations and having planned strategies on how to deal with them can decrease their rate and improve the patient's reconstructive journey.
Herein, the authors present 4 examples of significant complications in complex microvascular head and neck cancer reconstruction, encountered for the last 10 years: compression and kinking of the vascular pedicle, lack of planning of external skin coverage in osteoradionecrosis, management of the vessel-depleted neck, and vascular donor site morbidity after fibula harvest.
The authors reflect on the causes and propose preventative strategies in each peri-operative stage.
头颈部区域的游离皮瓣重建是一个复杂的领域，患者的合并症、放射治疗、肿瘤复发以及临床情况的多样性使得一些病例极具挑战性，且容易出现严重并发症。尽管游离皮瓣失败率较低，但皮瓣失败对患者的影响却极为严重。
认识并预测高风险的术中及术后情况，并制定应对策略，可降低其发生率，改善患者的重建过程。
在此，作者展示了过去10年中在复杂的微血管头颈部癌症重建中遇到的4例严重并发症：血管蒂受压和扭曲、放射性骨坏死中外部皮肤覆盖的规划不足、血管缺失颈部的处理以及腓骨采集后血管供区的并发症。
作者反思了各围手术期阶段的原因并提出了预防策略。
