Caruntu Ana, Moraru Liliana, Comaneanu Raluca Monica, Costache Raluca Simona, Farcasiu Titus Alexandru, Scheau Cristian, Costache Daniel Octavian, Caruntu Constantin
Department of Oral and Maxillofacial Surgery, 'Carol Davila' Central Military Emergency University Hospital, Bucharest 010825, Romania.
Faculty of Dental Medicine, 'Titu Maiorescu' University, Bucharest 031593, Romania.
Exp Ther Med. 2022 May;23(5):364. doi: 10.3892/etm.2022.11291. Epub 2022 Apr 1.
Since the COVID-19 pandemic outbreak, the medical systems were challenged by continuously increasing numbers of infections and faced critical issues when trying to find solutions for patients suffering from other diseases, including patients with head and neck cancers. Complex surgeries were delayed due to an acute deficit of specialized intensive care medical staff and equipment, which were redirected towards COVID-19 hospitalized cases, with irreversible consequences for the patients. In the present study, the case of locally advanced head and neck cancer was presented, which was treated radically during the heaviest wave of the COVID-19 pandemic in Romania using an alternative approach for immediate defect reconstruction. The case of locally advanced buccal carcinoma (staged T4aN0Mx) was reported, where radical tumor excision was followed by immediate reconstruction using a combination of two regional flaps, temporal and submental, in order to provide timely and optimal medical care. In the difficult context of the COVID-19 pandemic, the standard reconstructive technique, which is the free vascularized tissue transfer, could not be performed for this patient, due to the acute deficit of anesthetists and associated medical staff, as well as the lack of free beds in intensive care units. Combinations of local and regional flaps, such as temporal muscle flap and submental flap, are simple and accessible surgical techniques that require reduced surgical time, minimal equipment, and basic surgical training, advantages that become crucial in historically challenging times, such as a global pandemic. Individual cases, like elderly patients or patients with severe comorbidities, should be considered for these types of reconstructive techniques: simple solutions, single or in combination, which may be an improved therapeutic option for these patients.
自新冠疫情爆发以来，医疗系统面临着感染人数持续增加的挑战，在为包括头颈癌患者在内的其他疾病患者寻找解决方案时面临关键问题。由于专业重症医护人员和设备严重短缺，复杂手术被推迟，这些人员和设备被重新调配用于新冠住院病例，给患者带来了不可逆转的后果。在本研究中，介绍了一例局部晚期头颈癌病例，该病例在罗马尼亚新冠疫情最严重期间采用替代方法进行即刻缺损重建，接受了根治性治疗。报告了一例局部晚期颊癌（T4aN0Mx分期）病例，在根治性肿瘤切除后，立即使用颞部和颏下两个区域皮瓣联合进行重建，以便提供及时和最佳的医疗护理。在新冠疫情的艰难背景下，由于麻醉师和相关医护人员严重短缺，以及重症监护病房没有空床，该患者无法采用标准的重建技术，即游离血管化组织移植。局部和区域皮瓣的联合应用，如颞肌皮瓣和颏下皮瓣，是简单易行的手术技术，所需手术时间短、设备最少且只需基本的外科培训，在像全球大流行这样具有历史挑战性的时期，这些优势变得至关重要。对于老年患者或患有严重合并症的患者等个体病例，应考虑采用这类重建技术：简单的解决方案，单一或联合使用，这可能是这些患者更好的治疗选择。
