Chiang Liang-Jui, Lee Yao-Chou
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Plast Reconstr Surg Glob Open. 2023 Sep 19;11(9):e5278. doi: 10.1097/GOX.0000000000005278. eCollection 2023 Sep.
In the realm of oncologic reconstructive surgery, local or distant autologous tissue is frequently used to improve function and appearance. Due to advances in microsurgery and intensive care, reconstructive free flap surgery has become the standard treatment for head and neck cancer. However, the complexity of interdisciplinary intervention and prolonged surgical time inevitably increase the risk of cross-contamination, potentially leading to donor site metastasis. According to the literature, tumor transmission to the donor site of free flaps is extremely rare. We present the case of a 54-year-old man with left tongue squamous cell carcinoma. Three months after tumor ablation and reconstruction with a free anterolateral thigh flap, the patient presented with a mass on the donor site of the left thigh, which was proven to be a metastasis. A systemic workup revealed multiple metastases. Six months after reconstruction, the patient died of COVID-19 pneumonia. The incidence and risk factors of donor site metastasis are not well known. The primary causes are direct implantation or hematogenous spread. Cross-contamination is primarily prevented by the surgeon's awareness and avoidance. The development of new-onset lesions at the donor site warrants additional testing to detect systemic disease progression during follow-up.
在肿瘤重建外科领域，局部或远处自体组织常被用于改善功能和外观。由于显微外科和重症监护技术的进步，游离皮瓣重建手术已成为头颈癌的标准治疗方法。然而，多学科干预的复杂性和手术时间的延长不可避免地增加了交叉污染的风险，可能导致供区转移。根据文献报道，肿瘤转移至游离皮瓣供区极为罕见。我们报告一例54岁男性左舌鳞状细胞癌患者。在肿瘤切除并用游离股前外侧皮瓣重建三个月后，患者左大腿供区出现肿块，经证实为转移瘤。全面的系统检查发现多处转移。重建六个月后，患者死于新型冠状病毒肺炎。供区转移的发生率和危险因素尚不明确。主要原因是直接种植或血行播散。交叉污染主要通过外科医生的意识和避免措施来预防。供区出现新发病变需要进一步检查，以在随访期间检测全身疾病进展情况。
