小儿患者游离腓骨瓣面部重建术后的结果
Post-operative Outcomes in Pediatric Patients Following Facial Reconstruction With Fibula Free Flaps.
作者信息
Slijepcevic Allison A, Wax Mark K, Hanasono Matthew, Ducic Yadranko, Petrisor Daniel, Thomas Carissa M, Shnayder Yelizaveta, Kakarala Kiran, Pipkorn Patrik, Puram Sidharth V, Rich Jason, Rezaee Rod, Pittman Amy, Troob Scott
机构信息
Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA.
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
Laryngoscope. 2023 Feb;133(2):302-306. doi: 10.1002/lary.30219. Epub 2022 Jun 2.
EDUCATIONAL OBJECTIVE
Assess outcomes of pediatric facial reconstruction with fibula free flaps.
OBJECTIVES
Free flap reconstruction of complex maxillofacial defects in pediatric patients is rare. Post-operative complications, donor site morbidity, impact on craniofacial growth, and oro-dental rehabilitation are unknown. Our study assesses the outcomes of pediatric maxillofacial reconstruction with composite fibula free flaps.
STUDY DESIGN
Retrospective chart review.
METHODS
Multi-institutional retrospective chart review from 2000 to 2020 on pediatric patients undergoing maxillomandibular reconstruction with fibula free flaps.
RESULTS
Eighty-seven patients underwent 89 surgeries; 5 maxillary and 84 mandibular defects. Median age: 12 years. Defects were acquired following resection of sarcoma/carcinoma 44% or benign tumors 50%. 73% of cases had immediate free flap reconstruction. Closing osteotomies were reported in 74%; 1 in 40%, 2 in 27%, and more than 2 in 6.7%. Hardware was used in 98% and removed in 25%. 9.2% demonstrated long-term hardware exposure, greater than 3 months following reconstruction. Short-term complications: wound infection 6.7%, flap salvage/failure 2.2%, fistula 1.1%, and compromised craniofacial growth: 23%. Two patients developed trismus. Long-term fibula donor site complications: hypertrophic scarring: 3.4%, dysesthesia: 1.1%, and long-term gait abnormality: 1.1%. Dental rehabilitation was performed in 33%. Post-operative speech outcomes showed 94% with fully intelligible speech.
CONCLUSION
Pediatric maxillary and mandible defects repaired with fibula free flaps demonstrated complication rates comparable to the adult free flap population. Long-term follow-up did not demonstrate adverse outcomes for craniofacial growth. Hardware for flap retention was utilized and remained in place with minimal exposure. Post-operative gait abnormality is rare.
LEVEL OF EVIDENCE
3 Laryngoscope, 133:302-306, 2023.
教育目标
评估游离腓骨瓣用于小儿面部重建的效果。
目的
小儿患者复杂颌面部缺损的游离瓣重建很少见。术后并发症、供区发病率、对颅面生长的影响以及口腔牙齿修复情况尚不清楚。我们的研究评估了复合游离腓骨瓣用于小儿颌面部重建的效果。
研究设计
回顾性病历审查。
方法
对2000年至2020年接受游离腓骨瓣进行颌骨重建的小儿患者进行多机构回顾性病历审查。
结果
87例患者接受了89次手术；5例上颌骨缺损和84例下颌骨缺损。中位年龄：12岁。缺损是在切除肉瘤/癌（44%）或良性肿瘤（50%）后出现的。73%的病例进行了即刻游离瓣重建。74%的病例报告了截骨闭合情况；一处截骨闭合的占40%，两处的占27%，两处以上的占6.7%。98%的病例使用了内固定，25%的病例进行了内固定取出。9.2%的病例在重建后3个月以上出现长期内固定外露。短期并发症：伤口感染6.7%，皮瓣挽救/失败2.2%，瘘管1.1%，颅面生长受限：23%。两名患者出现牙关紧闭。腓骨供区长期并发症：瘢痕增生：3.4%，感觉异常：1.1%，长期步态异常：1.1%。33%的患者进行了牙齿修复。术后语音结果显示94%的患者语音完全清晰可懂。
结论
游离腓骨瓣修复小儿上颌骨和下颌骨缺损的并发症发生率与成人游离瓣人群相当。长期随访未显示对颅面生长有不良影响。用于固定皮瓣的内固定被使用且外露情况最少。术后步态异常罕见。
证据级别
3《喉镜》，133:302 - 306，2023年
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