Bhathena H M, Savant D N, Kavarana N M, Parikh D M, Sanghvi V D
Tata Memorial Hospital, Parel, Bombay, India.
Acta Chir Plast. 1996;38(2):43-9.
In 75 patients following ablative surgery of head and neck cancer, reconstruction was attempted with free tissue transfer techniques under magnification. It was possible to do free tissue transfers in 69 cases. In 6 cases it was not possible to harvest free flaps successfully and alternative reconstructive procedure was carried out due to unavoidable circumstances and various reasons: 1. unsuitable venous drainage, as in Anterior Rib Osteomyocutaneous Composite Flap, AROCF (2 cases), 2. injury to vessels during flap harvest, as in parascapular flap (1 case), 3. residual disease unable to excise (2 cases) and 4. unsuitable proposition (1 case), due to emergency curfew imposed suddenly. These 6 cases were not included in the study. Free tissue transfer was successful in 64 cases (92.7%) and there was a total failure in 5 cases where delayed secondary salvage surgery was performed. Out of 69 cases, in 65 cases reconstructions were carried out immediately, primarily as one-stage operative procedure. Their functional, cosmetic results and complications during the operative and post-operative period are analyzed and discussed. Inter-maxillary fixation was never used to maintain the bite alignment. All cases were given a bite guide prosthesis in the early post-operative period, to improve the bite alignment when it was necessary.
在75例接受头颈部癌症消融手术的患者中，尝试在放大条件下采用游离组织移植技术进行重建。69例成功进行了游离组织移植。6例因不可避免的情况和各种原因未能成功获取游离皮瓣，转而采用替代重建手术：1. 静脉引流不合适，如在前肋骨骨肌皮复合瓣（AROCF）中（2例）；2. 皮瓣获取过程中血管损伤，如肩胛旁皮瓣（1例）；3. 残留疾病无法切除（2例）；4. 由于突然实施紧急宵禁导致提议不合适（1例）。这6例未纳入研究。游离组织移植成功64例（92.7%），5例完全失败，随后进行了延迟的二次挽救手术。在69例中，65例立即进行重建，主要作为一期手术操作。对其功能、美容效果以及手术和术后期间的并发症进行了分析和讨论。从未使用颌间固定来维持咬合对齐。所有病例在术后早期均佩戴咬合引导假体，必要时改善咬合对齐。
