Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, SeoulAsan Medical Center, Seoul, Korea.
Ann Plast Surg. 2023 Aug 1;91(2):257-264. doi: 10.1097/SAP.0000000000003629.
This study aimed to compare the effects of motor-innervated free flap on sequential changes of swallowing function in patients undergoing total or near-total glossectomy with laryngeal preservation.
The medical charts of 21 patients who underwent tongue reconstruction after total or near-total glossectomy between April 2015 and December 2020 were retrospectively reviewed. Patients were divided into groups by reconstruction type: conventional, reconstruction using an anterolateral thigh free flap (n = 11), and dynamic, reconstruction using an anterolateral thigh with innervated vastus lateralis flap (n = 10). Demographics, surgical details, and survival outcomes were investigated. A videofluoroscopic penetration-aspiration scale and functional outcome swallowing scale were analyzed according to postoperative time courses, classified as within 6 months, 6 to 12 months, and after 12 months postoperative. A time-to-event analysis was performed for gastrostomy tube status.
The dynamic group showed improved swallowing outcomes at 6 to 12 months postoperative (dynamic vs conventional group, penetration-aspiration scale: 3 ± 1.51 vs 6 ± 1.63, P = 0.024; functional outcome swallowing scale: 1.89 ± 1.36 vs 4 ± 1.41, P = 0.009). In the multivariate analysis, the dynamic group showed a decreased probability of decompensated swallowing function at 6 to 12 months postoperative (odds ratio, 0.062; 95% confidence interval, 0.004-1.084; P = 0.057). A time-to-event analysis revealed no significant difference in gastrostomy tube status between the dynamic and the conventional group.
Considering higher mortality in patients subjected to total or near-total glossectomy, dynamic reconstruction with motor-innervated free flap is worth to perform in terms of enhancing the swallowing function within 1-year postoperative period, thereby improving the quality of life.
本研究旨在比较运动神经支配游离皮瓣对接受全舌或近全舌切除及喉保留的患者吞咽功能的连续变化的影响。
回顾性分析 2015 年 4 月至 2020 年 12 月期间接受全舌或近全舌切除后舌重建的 21 例患者的病历。根据重建类型将患者分为常规组（n=11）、股前外侧游离皮瓣重建组（n=10）和动力组（股前外侧带运动神经支配的股外侧肌皮瓣重建组）。调查了人口统计学、手术细节和生存结果。根据术后时间进程，使用视频透视渗透-吸入量表和功能结果吞咽量表进行分析，分为 6 个月内、6 至 12 个月和 12 个月后。对胃造口管状态进行了时间事件分析。
动力组在术后 6 至 12 个月时吞咽功能改善（动力组与常规组相比，渗透-吸入量表：3±1.51 对 6±1.63，P=0.024；功能结果吞咽量表：1.89±1.36 对 4±1.41，P=0.009）。在多变量分析中，动力组在术后 6 至 12 个月时吞咽功能失代偿的概率降低（优势比，0.062；95%置信区间，0.004-1.084；P=0.057）。时间事件分析显示，动力组与常规组之间胃造口管状态无显著差异。
考虑到全舌或近全舌切除患者的死亡率较高，运动神经支配游离皮瓣的动力重建在术后 1 年内增强吞咽功能方面具有一定价值，从而提高生活质量。
