Truelson J M, Leach J L, Close L G
University of Texas Southwestern Medical Center at Dallas 75235-9035.
Otolaryngol Head Neck Surg. 1994 Nov;111(5):557-60. doi: 10.1177/019459989411100504.
Reliable reconstructive techniques are essential in the surgical treatment of head and neck cancer patients. Free flaps have often been used as reconstructive options of last resort in the head and neck because of the need for added technical skill, a longer operating time, and a perception of poor reliability. This study reviews our experience with 39 free flaps performed by the Otolaryngology-Head and Neck Surgery Service. For the first 17 cases, an interrupted anastomotic technique was used; a running technique was performed in the remaining 22 cases. The average total ischemic time (3.7 vs. 2.7 hours; p < 0.001) was significantly less with a running technique. There were 10 complications: 7 minor would problems, 1 death from aspiration without surgical wound/flap problem, and 2 cases requiring second flaps (1 flap necrosis, 1 fistula with healthy free flap). No statistical correlation was found between complications and ischemic time, suture technique, age, or hospital (five hospitals). Free flaps are reliable and may obviate the need for sacrifice of trunk muscles for wound closure (e.g., fascicocutaneous free flaps instead of myocutaneous flaps); therefore we recommend revascularized free flaps as the primary mode of reconstruction for head and neck defects.
可靠的重建技术在头颈部癌症患者的外科治疗中至关重要。由于需要额外的技术技能、更长的手术时间以及可靠性较差的观念，游离皮瓣在头颈部常被用作最后的重建选择。本研究回顾了我们耳鼻喉头颈外科实施的39例游离皮瓣的经验。前17例采用间断吻合技术；其余22例采用连续技术。连续技术的平均总缺血时间（3.7小时对2.7小时；p<0.001）明显更短。共有10例并发症：7例轻微伤口问题，1例因误吸死亡且无手术伤口/皮瓣问题，2例需要二次皮瓣（1例皮瓣坏死，1例健康游离皮瓣出现瘘管）。未发现并发症与缺血时间、缝合技术、年龄或医院（五家医院）之间存在统计学相关性。游离皮瓣是可靠的，并且可能无需为关闭伤口而牺牲躯干肌肉（例如，使用筋膜皮游离皮瓣而非肌皮瓣）；因此，我们建议将血管化游离皮瓣作为头颈部缺损重建的主要方式。
