Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco Medical Center, San Francisco, California, USA.
Laryngoscope. 2024 Apr;134(4):1642-1647. doi: 10.1002/lary.31081. Epub 2023 Sep 29.
Microvascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to describe outcomes of free flap reconstruction for IFS defects, determine the optimal time to perform reconstruction, and if anti-fungal medications or other risk factors of an immunocompromised patient population affect reconstructive outcomes.
Retrospective review of reconstruction for IFS (2010-2022). Age, BMI, hemoglobin A1c, number of surgical debridements, and interval from the last debridement to reconstruction were compared between patients with delayed wound healing versus those without. Predictor variables for delayed wound healing and the effect of time on free flap reconstruction were analyzed.
Twenty-seven patients underwent free flap reconstruction for IFS. Three patients were immunocompromised from leukemia and 21 had diabetes mellitus (DM). Patients underwent an average of four surgical debridements for treatment of IFS. The interval from the last IFS debridement to flap reconstruction was 5.58 months (±5.5). Seven flaps (25.9%) had delayed wound healing. A shorter interval of less than 2 months between the last debridement for IFS and reconstructive free flap procedure was associated with delayed wound healing (Fisher Exact Test p = 0.0062). Other factors including DM, BMI, HgA1c, and bone reconstruction were not associated with delayed wound healing.
Patients with maxillectomy defects from IFS can undergo microvascular-free flap reconstruction with good outcomes while on anti-fungal medication. Early reconstruction in the first 2 months after the last IFS debridement is associated with delayed wound healing.
4 Laryngoscope, 134:1642-1647, 2024.
游离组织皮瓣移植术常用于恶性肿瘤患者的中面部缺损重建，但侵袭性真菌性鼻窦炎（IFS）患者的重建效果研究尚缺乏。我们旨在描述游离皮瓣重建用于 IFS 缺损的结果，确定进行重建的最佳时间，以及抗真菌药物或其他免疫功能低下患者人群的风险因素是否会影响重建效果。
回顾性分析 2010 年至 2022 年 IFS 重建病例。比较愈合不良患者与愈合良好患者的年龄、BMI、糖化血红蛋白（HbA1c）、手术清创次数以及从最后一次清创到重建的时间间隔。分析愈合不良的预测变量以及时间对游离皮瓣重建的影响。
27 例患者因 IFS 接受游离皮瓣重建。3 例患者因白血病导致免疫功能低下，21 例患者患有糖尿病（DM）。患者平均接受了 4 次清创手术来治疗 IFS。从最后一次 IFS 清创到皮瓣重建的时间间隔为 5.58 个月（±5.5）。7 个皮瓣（25.9%）出现愈合不良。IFS 最后一次清创与重建游离皮瓣之间的间隔小于 2 个月与愈合不良相关（Fisher 精确检验，p=0.0062）。其他因素，包括 DM、BMI、HgA1c 和骨重建，与愈合不良无关。
在接受抗真菌药物治疗的同时，IFI 患者上颌骨缺损可接受微血管游离皮瓣重建，且效果良好。最后一次 IFS 清创后 2 个月内早期重建与愈合不良有关。
4 级，《喉镜》杂志，134：1642-1647，2024 年。
