Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Curr Opin Otolaryngol Head Neck Surg. 2021 Aug 1;29(4):237-243. doi: 10.1097/MOO.0000000000000725.
The strain on healthcare resources in light of the COVID-19 pandemic has forced many head and neck surgeons to explore reconstructive options that may decrease length of stay. Here, we review three common and versatile regional flaps used in head and neck reconstruction that are comparable alternatives to free tissue transfer.
Initial anatomic descriptions of the facial artery musculocutaneous (FAMM) flap, the supraclavicular artery island flap and the submental artery island flap were published decades ago. Since then, many have proposed modifications to these descriptions to improve technical ease and patient outcomes. Benefits of regional flaps include ease of harvest, comparable outcomes to free tissue microvascular flaps, shorter operative time and hospital length of stay. Drawbacks to regional flaps include limitations to size and reach, partial necrosis, wound dehiscence and surgeon experience. The integrity of the vascular pedicle is also contingent upon vessel preservation during the cancer ablation.
Although a resurgence of regional flaps began well before the COVID-19 pandemic, many institutions began looking for alternatives to free flap reconstruction to conserve healthcare resources and minimize patient hospitalization time in the past year. There has been a revival of regional flaps such as the FAMM, supraclavicular and submental flaps that are valuable reconstructive options for many defects of the head and neck.
综述目的：鉴于 COVID-19 大流行对医疗资源造成的压力，许多头颈部外科医生都在探索可能缩短住院时间的重建方案。在此，我们将回顾三种常用于头颈部重建的常见且多功能的区域性皮瓣，它们是游离组织移植的可替代选择。
最新发现：面部动脉肌皮瓣（FAMM）、锁骨上动脉岛状瓣和颏下动脉岛状瓣的最初解剖描述在几十年前就已发表。此后，许多人对这些描述进行了改进，以提高技术的便利性和患者的预后。区域性皮瓣的优点包括易于采集、与游离组织微血管皮瓣相当的结果、较短的手术时间和住院时间。区域性皮瓣的缺点包括尺寸和覆盖范围受限、部分坏死、伤口裂开和外科医生经验。血管蒂的完整性还取决于在癌症消融过程中对血管的保护。
总结：尽管在 COVID-19 大流行之前，区域性皮瓣的使用就已重新兴起，但在过去一年中，许多机构开始寻找游离皮瓣重建的替代方案，以节省医疗资源并尽量减少患者的住院时间。面部动脉肌皮瓣、锁骨上动脉岛状瓣和颏下动脉岛状瓣等区域性皮瓣的应用得到了复兴，它们对头颈部许多缺损是有价值的重建选择。
