Inouye Daniel, Zhou Sheng, Clark Bhavishya, Swanson Mark, Chambers Tamara
Otolaryngology-Head and Neck Surgery, Keck School of Medicine at University of Southern California, Los Angeles, USA.
Cureus. 2021 Dec 1;13(12):e20088. doi: 10.7759/cureus.20088. eCollection 2021 Dec.
Due to the microvascular effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), head and neck reconstructive surgeries utilizing free tissue transfers may be profoundly affected by SARS-CoV-2 infection in the immediate postoperative period. Our objective is to describe two adult patients who developed SARS-CoV-2 after undergoing relatively uncomplicated segmental mandibulectomies. In both cases, the patients were initially negative for SARS-CoV-2, underwent relatively uncomplicated segmental mandibulectomies with fibula free flap reconstructions, and were later discharged in stable conditions. Both patients subsequently experienced significant infectious sequelae at the donor and recipient sites with near-total split-thickness skin graft loss in the donor sites in the setting of postoperative SARS-CoV-2 infection. The first patient developed sepsis and gangrenous changes to his fibula donor site requiring four operative debridements and partial amputation with subsequent osteomyelitis of the remaining fibula. The second patient experienced dehiscence of the oral fibula free flap as well as a 22 cm phlegmon at the fibula donor site that required surgical debridement. In consideration of these cases, SARS-CoV-2 infection during the immediate postoperative period of head and neck reconstruction procedures may elevate the risk of major wound complications. Special consideration must be taken when performing free tissue transfers during the COVID-19 pandemic.
由于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的微血管效应，利用游离组织移植的头颈部重建手术在术后即刻可能会受到SARS-CoV-2感染的严重影响。我们的目的是描述两名成年患者，他们在接受相对简单的节段性下颌骨切除术后感染了SARS-CoV-2。在这两例病例中，患者最初SARS-CoV-2检测呈阴性，接受了相对简单的节段性下颌骨切除术并进行了腓骨游离皮瓣重建，随后病情稳定出院。两名患者随后在供体和受体部位均出现了严重的感染后遗症，在术后SARS-CoV-2感染的情况下，供体部位几乎完全出现了中厚皮片丢失。第一名患者发生了脓毒症，其腓骨供体部位出现坏疽性改变，需要进行四次手术清创和部分截肢，随后剩余腓骨发生骨髓炎。第二名患者出现口腔腓骨游离皮瓣裂开，腓骨供体部位出现22厘米的蜂窝织炎，需要进行手术清创。考虑到这些病例，头颈部重建手术术后即刻感染SARS-CoV-2可能会增加严重伤口并发症的风险。在新冠疫情期间进行游离组织移植时必须特别谨慎。
