O'Connell J E, Koumoullis H, Lowe D, Rogers S N
Clinical Fellow, Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
Surgical Trainee, Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
Br J Oral Maxillofac Surg. 2022 Sep;60(7):915-921. doi: 10.1016/j.bjoms.2022.01.016. Epub 2022 Feb 18.
The aim of this study was to report the patient characteristics and radial fracture rates in a consecutive series of composite radial forearm free flap (CRFFF) for head and neck reconstruction over a 31-year period. The patients were identified from between 1990 to 2020 inclusive from theatre records and records from previous analyses at the Unit on free flap outcomes. Electronic case notes were accessed where available, to gather information on the operation, histopathology, and radiographs. Patients were categorised into three groups for analysis: (1) new oral cancers with a composite radial being the first choice of flap, (2) new oral cancers with a composite radial being the choice of flap following compromise of another bony flap, (3) osteoradionecrosis (ORN) cases. There were 103 CRFFF cases, median (IQR) age 69 (59-80) years, comprising 78 (Group 1), 5 (Group 2) and 20 (Group 3). The CRFFF failure rate was 6% (6/103) and the radius fracture rate was also 6% (6/103), both with 95% confidence interval 2.2-12.2%. Of the 6 radius fractures, 1 underwent surgical management (rush nailing), 1 died in hospital and the others managed with cast immobilisation. Two-year overall survival after surgery for the103 patients was 54% (SE 5%), while 5-year survival was 40% (SE 5%). In conclusion, in spite of the familiarity with other bone flaps such as fibular free flap, DCIA, scapula, and the limited bone stock and potential fracture related morbidity associated with the CRFFF, this flap still has a place in the surgical reconstructive armamentarium.
本研究的目的是报告在31年期间连续进行的一系列用于头颈部重建的桡骨前臂复合游离皮瓣（CRFFF）的患者特征及桡骨骨折发生率。通过手术记录以及该科室先前关于游离皮瓣结果分析的记录，确定了1990年至2020年（含）期间的患者。如有可用的电子病历，会查阅以收集有关手术、组织病理学和X光片的信息。患者被分为三组进行分析：（1）以桡骨复合皮瓣为首选皮瓣的新发口腔癌患者；（2）在另一块骨皮瓣出现问题后选择桡骨复合皮瓣的新发口腔癌患者；（3）放射性骨坏死（ORN）病例。共有103例CRFFF病例，中位（IQR）年龄为69（59 - 80）岁，其中包括78例（第1组）、5例（第2组）和20例（第3组）。CRFFF失败率为6%（6/103），桡骨骨折发生率也为6%（6/103），两者的95%置信区间均为2.2 - 12.2%。在6例桡骨骨折中，1例接受了手术治疗（紧急钉扎），1例在医院死亡，其他患者采用石膏固定治疗。这103例患者术后两年总生存率为54%（标准误5%），而五年生存率为40%（标准误5%）。总之，尽管对其他骨皮瓣如腓骨游离皮瓣、腹壁下动脉穿支皮瓣、肩胛骨皮瓣较为熟悉，且CRFFF存在骨量有限以及与骨折相关的潜在发病率，但该皮瓣在手术重建器械库中仍占有一席之地。
