Stark B, Nathanson A, Hedén P, Jernbeck J
Department of Plastic and Reconstructive Surgery, Karolinska Hospital, Stockholm, Sweden.
ORL J Otorhinolaryngol Relat Spec. 1998 Jul-Aug;60(4):212-7. doi: 10.1159/000027596.
Between 1989 and 1996, 47 patients with an intraoral squamous cell carcinoma underwent tumor resection and reconstruction with a free volar forearm flap. Tumor resection and neck dissection were performed by a head and neck surgeon and the free tissue transfer by a plastic surgeon. Preoperative radiation therapy was given to 44 of 47 patients and postoperative radiation therapy to 2. One other patient was not irradiated. There were 15 females and 32 males, with a mean age of 61 years. The primary site of the cancer was the tongue in 15 cases, the floor of the mouth in 15, the tonsil in 10, the bucca in 3 and the retromolar trigone in 4 cases. The flap was harvested from the left forearm in 34 and from the right in 13 patients. The mean operation time was 10 h (range 6-20) and the mean intraoperative bleeding was 486 ml (250-2,500). Forty-four of 46 flaps healed completely. Twelve revisions on 9 free flaps were performed between 6 h and 6 days postoperatively. Overall revisional surgery was done in 9 of 47 cases (19%). Two flaps could not be saved (4%). Infections/fistulas in the neck occurred in 11 of 46 cases (24%). Complete healing of the donor site occurred at a mean of 2.5 months (1-5). Nine patients developed complications at the donor site, 3 hematomas and 6 superficial infections (19%). Twenty-seven of 47 patients are still alive (57%). The mean survival time was 49 months (16-71).
1989年至1996年间，47例口腔鳞状细胞癌患者接受了肿瘤切除及游离掌侧前臂皮瓣重建手术。肿瘤切除和颈部清扫由头颈外科医生进行，游离组织移植由整形外科医生完成。47例患者中有44例接受了术前放疗，2例接受了术后放疗。另有1例患者未接受放疗。患者中女性15例，男性32例，平均年龄61岁。癌症的原发部位：舌部15例，口底15例，扁桃体10例，颊部3例，磨牙后三角区4例。34例患者的皮瓣取自左前臂，13例取自右前臂。平均手术时间为10小时（范围6 - 20小时），平均术中出血量为486毫升（250 - 2500毫升）。46例皮瓣中有44例完全愈合。9例游离皮瓣在术后6小时至6天进行了12次修复。47例患者中有9例进行了总体修复手术（19%）。2例皮瓣未能挽救（4%）。46例患者中有11例发生颈部感染/瘘（24%）。供区平均在2.5个月（1 - 5个月）完全愈合。9例患者供区出现并发症，3例血肿，6例表浅感染（19%）。47例患者中有27例仍存活（57%）。平均生存时间为49个月（16 - 71个月）。
