Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA.
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2021 Nov;165(5):636-646. doi: 10.1177/0194599821990682. Epub 2021 Feb 23.
Review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis.
Retrospective multi-institutional review.
Tertiary care centers.
Patients included those undergoing free flap reconstructions for osteonecrosis of the head and neck (N = 232). Data included demographics, defect, donor site, radiation history, perioperative management, diet status, recurrence rates, and long-term quality-of-life outcomes. Quality-of-life outcomes were measured using the University of Washington Quality of Life (UW-QOL) survey.
Overall flap success rate was 91% (n = 212). Relative to preoperative diet, 15% reported improved diet function at 3 months following reconstruction and 26% at 5 years. Osteonecrosis recurred in 14% of patients (32/232); median time to onset was 11 months. Cancer recurrence occurred in 13% of patients (29/232); median time to onset was 34 months. Results from the UW-QOL questionnaire were as follows: no pain (45%), minor or no change in appearance (69%), return to baseline endurance level (37%), no limitations in recreation (40%), no changes in swallowing following reconstruction (28%), minor or no limitations in mastication (29%), minor or no speech difficulties (93%), no changes in shoulder function (84%), normal taste function (19%), normal saliva production (27%), generally excellent mood (44%), and no or minimal anxiety about cancer (94%).
The majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life.
回顾游离皮瓣重建治疗骨坏死的长期临床和生活质量结果。
回顾性多机构研究。
三级护理中心。
纳入 232 例行游离皮瓣重建治疗头颈部骨坏死的患者。数据包括人口统计学、缺损、供区部位、放射史、围手术期管理、饮食状况、复发率和长期生活质量结果。生活质量结果采用华盛顿大学生活质量（UW-QOL）调查进行测量。
总皮瓣成功率为 91%（n=212）。与术前饮食相比，15%的患者在重建后 3 个月报告饮食功能改善，26%的患者在 5 年后报告饮食功能改善。14%的患者（32/232）发生骨坏死复发；中位发病时间为 11 个月。13%的患者（29/232）发生癌症复发；中位发病时间为 34 个月。UW-QOL 问卷结果如下：无疼痛（45%）、外观轻微或无变化（69%）、恢复基线耐力水平（37%）、娱乐活动无限制（40%）、重建后吞咽无变化（28%）、咀嚼功能轻微或无限制（29%）、言语困难轻微或无（93%）、肩部功能无变化（84%）、味觉功能正常（19%）、唾液分泌正常（27%）、总体情绪极佳（44%）和对癌症无或极少焦虑（94%）。
大多数患者在重建后维持或改善饮食，骨坏死或癌症复发率较低，UW-QOL 调查评分高于平均水平，提示功能和生活质量恢复良好。
