Urken Mark L, O'Malley Quinn, Sandler Mykayla, Xing Monica H, Ansari Edward, Mundi Neil, Buchbinder Daniel, Alon Eran, Okay Devin
THANC (Thyroid, Head and Neck Cancer) Foundation, New York, NY, USA.
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, NY, USA.
Craniomaxillofac Trauma Reconstr. 2022 Sep;15(3):253-263. doi: 10.1177/19433875211031361. Epub 2021 Jul 8.
case series.
The restoration of defects in a single procedure with microvascular free flap reconstruction has become a mainstay of head and neck surgery. Yet in patients with complex defects and pre-existing comorbid medical conditions, a staged-reconstructive approach can enhance the safety of the procedure and improve the patient's outcome.
We present 3 representative case examples of a larger series of patients who underwent reconstruction of major defects and discuss the usefulness of a staged-reconstructive approach in the management of complex patients.
All 3 patients, with an existing composite defect in the setting of prior radiation therapy, underwent successful staged-reconstructive surgery using a variety of free tissue and regional flap transfers.
A staged approach facilitates the reconstruction of complex composite defects, increases vessel availability, and mitigates the risk of flap failure. Although this approach commits the patient to multiple procedures and a more prolonged plan of care, it is preferable to 1 operation in specific complex situations with adverse, high-risk clinical features.
病例系列。
采用微血管游离皮瓣重建术一次性修复缺损已成为头颈外科的主要手段。然而，对于存在复杂缺损和既有合并症的患者，分期重建方法可提高手术安全性并改善患者预后。
我们展示了一系列接受重大缺损重建的患者中的3个典型病例，并讨论分期重建方法在复杂患者管理中的实用性。
所有3例患者在既往放疗背景下均存在复合缺损，均通过使用多种游离组织和区域皮瓣转移成功接受了分期重建手术。
分期方法有助于复杂复合缺损的重建，增加血管可用性，并降低皮瓣失败风险。尽管这种方法使患者需要接受多次手术和更长的护理计划，但在具有不良、高风险临床特征的特定复杂情况下，它比单次手术更可取。
