Department of Odontostomatological and Maxillofacial Sciences, Sapienza University, Rome, Italy.
Head and Neck Department, University of Verona, Verona, Italy.
Br J Oral Maxillofac Surg. 2024 Nov;62(9):801-806. doi: 10.1016/j.bjoms.2024.07.001. Epub 2024 Jul 15.
Microsurgery is the gold standard for hard and soft tissue reconstruction in head and neck neoplasia and malformations. Fibular, iliac crest, and scapular free flaps are the main choices for reconstructive surgery of the jaws. Although widely described in the literature, no statistical comparison analysis of the donor site morbidity of these has been performed to our knowledge. Therefore, in this study, the medical records of patients who underwent microsurgical jaw reconstruction at the Maxillofacial Oncological Reconstructive Surgery Unit of Umberto I General Hospital in Rome between 2011 and 2021 were analysed retrospectively. Inclusion criteria were complete clinical and radiological records, microsurgical reconstruction harvesting one of the three flaps, and a minimum follow up of 12 months. Principal donor site complications were recorded and compared among the flaps. The data were analysed using IBM SPSS Statistics (28.0.1.1, IBM Corp). The study enrolled 220 patients: 103 with deep circumflex iliac artery (DCIA) flaps, 87 with fibular free flaps (FFF), and 30 with scapular bone flaps (SBF). The main DCIA donor site complications were dysaesthesia (13.6%), abdominal hernia (2.9%), dehiscence (1.9%), infection (1.9%), and anterior superior iliac spinal fracture (1.9%). Similarly, the main FFF complications were dehiscence (8%), skin graft necrosis (6.9%), infection (5.7%), and dysaesthesia (3.4%). Subcutaneous seroma occurred in 13.3% of SBF patients and dehiscence in 6.7%. Regional dysaesthesia occurred significantly (p < 0.05) more often in DCIA than FFF or SBF patients. Dehiscence was significantly (p < 0.05) more frequent in FFF than DCIA or SBF patients. All flaps were safe and associated with low donor site morbidity. The jaws should be reconstructed selecting the flap that best satisfies the reconstructive needs based on the patient's clinical features.
显微外科手术是头颈部肿瘤和畸形软硬组织重建的金标准。游离腓骨、髂嵴和肩胛骨皮瓣是颌骨重建的主要选择。尽管在文献中广泛描述，但据我们所知，尚未对这些皮瓣供区发病率进行统计学比较分析。因此，在这项研究中，回顾性分析了 2011 年至 2021 年间在罗马翁贝托一世综合医院颌面肿瘤重建外科单元接受显微外科颌骨重建的患者的病历。纳入标准为完整的临床和影像学记录、采用三种皮瓣之一进行显微外科重建，以及至少 12 个月的随访。记录并比较了主要供区并发症。使用 IBM SPSS Statistics（28.0.1.1，IBM Corp）对数据进行分析。该研究共纳入 220 例患者：103 例采用深旋股外侧动脉（DCIA）皮瓣，87 例采用游离腓骨皮瓣（FFF），30 例采用肩胛骨骨瓣（SBF）。DCIA 主要供区并发症为感觉异常（13.6%）、腹疝（2.9%）、裂开（1.9%）、感染（1.9%）和前上髂脊骨折（1.9%）。同样，FFF 的主要并发症为裂开（8%）、皮片坏死（6.9%）、感染（5.7%）和感觉异常（3.4%）。13.3%的 SBF 患者出现皮下血清肿，6.7%的患者出现裂开。与 FFF 或 SBF 患者相比，DCIA 患者出现区域感觉异常的发生率显著更高（p<0.05）。与 DCIA 或 SBF 患者相比，FFF 患者的裂开发生率显著更高（p<0.05）。所有皮瓣均安全，供区并发症发生率低。应根据患者的临床特征，选择最能满足重建需求的皮瓣来重建颌骨。
