Meier J K, Spoerl S, Spanier G, Wunschel M, Gottsauner M J, Schuderer J, Reichert T E, Ettl T
Department of Cranio-Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
BMC Oral Health. 2021 Apr 19;21(1):198. doi: 10.1186/s12903-021-01563-7.
Microvascular tissue transfer (MTT) has been established as the gold standard in oral- and maxillofacial reconstruction. However, free flap surgery may be critical in multimorbid elderly patients and after surgery or radiotherapy, which aggravate microsurgery. This study evaluates indications and outcome of the submental island flap (SMIF) and the pectoralis major myocutaneous flap (PMMF) as alternatives to the free radial forearm flap (RFF).
This retrospective study included 134 patients who had undergone resection and reconstruction with SMIF, PMMF, or RFF at our department between 2005 and 2020. The level of comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). Primary outcome variables were flap success, complications, wound dehiscence, surgery duration, as well as time at the ICU and the ward (hospitalization). Chi-square tests, t-tests, and ANOVA were performed for statistics.
24 SMIFs, 52 RFFs, and 58 PMMFs were included in this study. The flap types did not significantly differ in terms of flap success, complications, and healing disorders. The SMIF presented a success rate of 95.8% and was significantly more often used in elderly patients (mean age = 70.2 years; p < 0.001) with increased comorbidities than the PMMF (p < 0.01) and RFF (p < 0.001). SMIF reconstruction reduced surgery duration (p < 0.001) and time at the ICU (p = 0.009) and the ward (p < 0.001) more than PMMF and RFF reconstructions. PMMF reconstruction was successful in 91.4% of patients and was more frequently used after head and neck surgery (p < 0.001) and radiotherapy (p < 0.001) than SMIF and RFF reconstructions. Patients undergoing PMMF reconstruction more frequently required segmental jaw resection and had presented with advanced tumor stages (both p < 0.001). Nicotine and alcohol abuse was more frequent in the RFF and PMMF groups (both p < 0.001) than in the SMIF group.
The pedicled SMIF represents a valuable reconstructive option for elderly patients with increased comorbidity because of the shorter duration of surgery and hospitalization. On the other hand, the PMMF serves as a solid backup solution after head and neck surgery or radiotherapy. The rates of flap success, complications, and healing disorders of both pedicled flaps are comparable to those of free flap reconstruction.
微血管组织移植（MTT）已成为口腔颌面重建的金标准。然而，游离皮瓣手术对于患有多种疾病的老年患者以及手术或放疗后的患者可能具有挑战性，因为这些情况会加重显微外科手术的难度。本研究评估颏下岛状皮瓣（SMIF）和胸大肌肌皮瓣（PMMF）作为游离桡侧前臂皮瓣（RFF）替代方案的适应症和疗效。
这项回顾性研究纳入了2005年至2020年间在我科接受SMIF、PMMF或RFF切除及重建手术的134例患者。采用年龄调整Charlson合并症指数（ACCI）来衡量合并症的程度。主要结局变量包括皮瓣成功率、并发症、伤口裂开、手术时长以及在重症监护病房（ICU）和病房的时间（住院时间）。进行卡方检验、t检验和方差分析以进行统计。
本研究纳入了24例SMIF、52例RFF和58例PMMF。皮瓣类型在皮瓣成功率、并发症和愈合障碍方面无显著差异。SMIF的成功率为95.8%，与PMMF（p<0.01）和RFF（p<0.001）相比，显著更常用于合并症增加的老年患者（平均年龄=70.2岁；p<0.001）。与PMMF和RFF重建相比，SMIF重建缩短了手术时长（p<0.001）、在ICU的时间（p=0.009）和在病房的时间（p<0.001）。PMMF重建在91.4%的患者中成功，与SMIF和RFF重建相比，在头颈手术（p<0.001）和放疗后（p<0.001）更频繁使用。接受PMMF重建的患者更频繁地需要节段性颌骨切除，且肿瘤分期较晚（均p<0.001）。RFF和PMMF组的尼古丁和酒精滥用情况比SMIF组更频繁（均p<0.001）。
带蒂SMIF是合并症增加的老年患者的一种有价值的重建选择，因为手术和住院时间较短。另一方面，PMMF是头颈手术或放疗后的可靠备用解决方案。两种带蒂皮瓣的皮瓣成功率、并发症和愈合障碍发生率与游离皮瓣重建相当。
