Shires Courtney B, Jackson Jataiveus, Moskovitz Jessica, Dewan Karuna
West Cancer Center, 7945 Wolf River Blvd, Germantown, TN 71115, USA.
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, LA 71118, USA.
J Pers Med. 2024 Jul 3;14(7):720. doi: 10.3390/jpm14070720.
Obesity remains a high-level risk factor for various cancers. Yet, some research has shown that higher BMIs may improve survival outcomes, particularly for head and neck squamous cell carcinoma (HNSCC). While this is a clear deviation from the norm, it raises the question of what other effects obesity may have on head and neck cancer patients, including surgical outcomes. Choosing the most appropriate flap for patients can be difficult for even experienced surgeons. Head and neck reconstructive surgeries are no exception to this rule and can be especially challenging. To produce the most favorable outcomes, a physician must be able to combine all flap attributes including donor and recipient site location, flap thickness, as well as each patient's individual risk factors such as prior radiation. The purpose of this study was to compare the outcomes of vertical rectus femoris myocutaneous (VRAM) and anterolateral thigh (ALT) flaps in overweight and obese individuals with varying head and neck cancers leaving large-sized defects to the outcomes in normal and underweight patients. A retrospective chart review was conducted of VRAM and ALT flaps performed over a period of 12 months at our university hospital for large head and neck reconstruction. Of the 17 ALT patients, 80% (4/5) of the underweight patients, 57% (4/7) of the normal weight patients, 50% (1/2) of the overweight patients, and 33% (1/3) of the obese patients experienced complications. Of the 15 VRAM patients, 40% (2/5) of the underweight patients, 83% (5/6) of the overweight patients, and 50% (1/2) of the obese patients experienced complications. In our small sample size, a smaller percentage of obese patients with head and neck cancer who underwent flap reconstruction surgery had complications when undergoing ALT flaps than VRAM flaps, which contrasts with the normal and underweight patients, who had less complications with VRAM flaps than ALT flaps.
肥胖仍然是多种癌症的高风险因素。然而，一些研究表明，较高的体重指数（BMI）可能会改善生存结果，尤其是对于头颈部鳞状细胞癌（HNSCC）。虽然这明显偏离了常态，但它引发了一个问题，即肥胖对头颈部癌症患者可能还有哪些其他影响，包括手术结果。即使是经验丰富的外科医生，为患者选择最合适的皮瓣也可能很困难。头颈部重建手术也不例外，而且可能特别具有挑战性。为了产生最有利的结果，医生必须能够综合考虑所有皮瓣的属性，包括供体和受体部位的位置、皮瓣厚度，以及每个患者的个体风险因素，如既往放疗史。本研究的目的是比较超重和肥胖的头颈部癌症患者在留下大尺寸缺损时，采用股直肌垂直肌皮瓣（VRAM）和股前外侧皮瓣（ALT）重建的结果与正常体重和体重过轻患者的结果。对我校医院在12个月内进行的用于大型头颈部重建的VRAM和ALT皮瓣手术进行了回顾性病历审查。在17例接受ALT皮瓣手术的患者中，体重过轻患者的并发症发生率为80%（4/5），正常体重患者为57%（4/7），超重患者为50%（1/2），肥胖患者为33%（1/3）。在15例接受VRAM皮瓣手术的患者中，体重过轻患者的并发症发生率为40%（2/5），超重患者为83%（5/6），肥胖患者为50%（1/2）。在我们的小样本中，接受皮瓣重建手术的肥胖头颈部癌症患者中，接受ALT皮瓣手术时发生并发症的比例低于接受VRAM皮瓣手术的患者，这与正常体重和体重过轻的患者相反，他们接受VRAM皮瓣手术时的并发症比接受ALT皮瓣手术时少。
