Noothanapati Nageswara R, Akali Nisha R, Buggaveeti Rahul, Balasubramanian Deepak, Mathew Jimmy, Iyer Subramania, Thankappan Krishnakumar
Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India.
Department of Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India.
Craniomaxillofac Trauma Reconstr. 2023 Sep;16(3):211-221. doi: 10.1177/19433875221109248. Epub 2022 Jun 16.
Salvage surgery is the treatment option in recurrences and second primary tumors. This paper aimed to study the options and outcomes of reconstruction and the predictors of poor reconstructive outcomes in salvage surgery for head and neck cancers.
This is a retrospective study of all patients who underwent reconstructive flap surgery as part of salvage surgery for head and neck cancers between the years 2004 and 2017.
The initial treatment may be single modality radiotherapy or surgery or multimodality with combinations of surgery, radiotherapy, and chemotherapy. Any pathology that required surgical salvage was included. Any procedures done purely as reconstructive surgery were excluded. Predictor variables included demographical, clinical, and treatment factors. The outcome parameter was the occurrence of any flap-related complication or not. The complications and morbidity related to the procedures are reported.
Ninety-three patients underwent loco-regional flaps (LRF group), and 100 had free flaps (FF group). Pectoralis major flap was the commonest flap used in 68 patients (73.1%). Anterolateral thigh (ALT) flap was the commonest free flap and comprised 41% of the FF group. Any skin-related complication was seen in 35 patients (37.6%) and 41 (41%), respectively, in LRF and FF subsets. Any flap-related complication was seen in 16 patients (17.2%) and 29 patients (29%), respectively, in LRF and FF subsets. A summary measure "any one of the complications" was seen in 46 (49.5%) and 57 (57%), respectively, in LRF and FF subsets. Univariate and multivariate analysis for any flap-related complication identified no statistically significant predictor.
Soft tissue flaps were preferred in salvage reconstruction, though the defects had a bony component. In the microvascular free flap reconstruction era, pectoralis major flap has shifted its role from a "workhorse flap" to a "salvage flap." About half of the patients develop some complications. Flap-related complications are also common. In salvage surgery, it is important that an appropriate flap is selected, suitable for the setting, according to the indications, neck, and patient conditions.
挽救性手术是复发性肿瘤和第二原发性肿瘤的治疗选择。本文旨在研究头颈部癌挽救性手术中重建的选择和结果以及重建效果不佳的预测因素。
这是一项对2004年至2017年间接受重建皮瓣手术作为头颈部癌挽救性手术一部分的所有患者的回顾性研究。
初始治疗可能是单一模式放疗或手术，或手术、放疗和化疗联合的多模式治疗。纳入任何需要手术挽救的病理情况。排除纯粹作为重建手术进行的任何操作。预测变量包括人口统计学、临床和治疗因素。结果参数是是否发生任何与皮瓣相关的并发症。报告了与手术相关的并发症和发病率。
93例患者接受了局部皮瓣（LRF组），100例接受了游离皮瓣（FF组）。胸大肌皮瓣是68例患者（73.1%）中最常用的皮瓣。股前外侧（ALT）皮瓣是最常见的游离皮瓣，占FF组的41%。LRF组和FF组分别有35例（37.6%）和41例（41%）出现任何与皮肤相关的并发症。LRF组和FF组分别有16例（17.2%）和29例（29%）出现任何与皮瓣相关的并发症。在LRF组和FF组中，分别有46例（49.5%）和57例（57%）出现“任何一种并发症”的综合指标。对任何与皮瓣相关并发症的单因素和多因素分析均未发现具有统计学意义的预测因素。
尽管缺损有骨成分，但在挽救性重建中软组织皮瓣更受青睐。在微血管游离皮瓣重建时代，胸大肌皮瓣的作用已从“主力皮瓣”转变为“挽救性皮瓣”。约一半的患者会出现一些并发症。与皮瓣相关的并发症也很常见。在挽救性手术中，根据适应症、颈部情况和患者条件选择合适的皮瓣非常重要。
