Hennocq Quentin, Caruhel Jean-Baptiste, Benassarou Mourad, Bouaoud Jebrane, Chaine André, Girod Angélique, Graillon Nicolas, Testelin Sylvie, Amor-Sahli Mélika, Foy Jean-Philippe, Bertolus Chloé
Sorbonne University, Paris, France.
Department of Maxillo-Facial Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.
Otolaryngol Head Neck Surg. 2025 Sep;173(3):592-602. doi: 10.1002/ohn.1284. Epub 2025 Apr 29.
The aim of our study was to determine the factors influencing the evolution of the total volume and bone volume of free flaps commonly used in head and neck surgery, with a 30-month prospective study, to establish volume change predictions and thus propose a degree of overcorrection to be expected before reconstruction.
We prospectively included all consecutive free flap.
Our maxillofacial surgery department between August 2021 and January 2024.
We collected information on preoperative, per-operative, and postoperative factors, on patients, surgical techniques, and adjuvant treatments. We measured on each postoperative imaging the overall flap volume and bone volume if applicable. Multivariate mixed models were then used to select clinical parameters associated with volume loss.
We included 166 flaps, performed on 155 patients. The mean age was 60.1 ± 15.1 years. A total of 634 imagings were segmented (487 computed tomography [CT] scans, 77%; 147 magnetic resonance imagings [MRIs], 23%). The use of the superior thyroid or lingual veins for venous anastomosis, such as the use of small couplers, resulted in negative volume changes. Predicted bone volumes decreased by 23% at 30 months for deep circumflex iliac artery (DCIA) free flaps, 19% for fibula free flap (FFF), and 38% for scapular system free flap (SFF).
These findings allow us to envisage a volume overcorrection of around 60% for fasciocutaneous or osteocutaneous flaps, and 75% for muscle or osteomuscular flaps. The choice of vein and microsurgical technique seems to have more impact on the evolution of free flap volume than patient characteristics or adjuvant treatments.
本研究旨在通过一项为期30个月的前瞻性研究，确定影响头颈外科常用游离皮瓣总体积和骨体积演变的因素，建立体积变化预测模型，从而提出重建前预期的过度矫正程度。
我们前瞻性纳入了所有连续的游离皮瓣。
2021年8月至2024年1月期间我们的颌面外科科室。
我们收集了关于术前、术中及术后因素、患者、手术技术和辅助治疗的信息。如果适用，我们在每次术后影像学检查中测量皮瓣的总体积和骨体积。然后使用多变量混合模型选择与体积丢失相关的临床参数。
我们纳入了155例患者的166个皮瓣。平均年龄为60.1±15.1岁。共分割了634次影像学检查（487次计算机断层扫描[CT]，占77%；147次磁共振成像[MRI]，占23%）。使用甲状腺上静脉或舌静脉进行静脉吻合，如使用小型吻合器，会导致体积出现负向变化。对于旋髂深动脉（DCIA）游离皮瓣，30个月时预测骨体积减少23%，腓骨游离皮瓣（FFF）减少19%，肩胛系统游离皮瓣（SFF）减少38%。
这些发现使我们能够设想，对于筋膜皮瓣或骨皮瓣，过度矫正量约为60%，对于肌肉瓣或骨肌瓣，过度矫正量约为75%。静脉的选择和显微外科技术似乎比患者特征或辅助治疗对游离皮瓣体积的演变影响更大
