Gürlek A, Miller M J, Amin A A, Evans G R, Reece G P, Baldwin B J, Schusterman M A, Kroll S S, Robb G L
Department of Plastic Surgery, M.D. Anderson Cancer Center, University of Texas, Houston, USA.
J Reconstr Microsurg. 1998 Jul;14(5):337-40. doi: 10.1055/s-2007-1000187.
The purpose of this study was to evaluate the use of free-tissue transfers for the reconstruction of radiation-induced complex injuries. The case files for patients who underwent reconstruction for radiation-induced injuries between May 1988 and November 1995 at The University of Texas M.D. Anderson Cancer Center were retrospectively reviewed. Thirty patients in whom 33 free flaps were done were included. Radiation-induced defects were located in the head and neck (n=23), extremities (n=4), chest wall (n=2), and inguinal area (n=1) The mean period between irradiation and injury was 78 months (range: 4 months to 38 years). Free-tissue transfer was successful in 97 percent (32/33) of patients. The overall complication rate was 40 percent (12/30). Flap donor sites included the fibula (n=12), latissimus dorsi (n=6), rectus abdominis (n=6), iliac crest (n=4), scapula (n=3), and radial forearm (n=2). Large-caliber vessels in the cervical, axillary, or inguinal regions were most commonly used to revascularize flaps. Vein grafts were used in five cases for the artery (2/5) or vein (3/5). Pedicle thrombosis occurred in three cases in recipient vessels located within the irradiated field. Two flaps were salvaged; one was lost, and the patient required a second free-flap reconstruction The mean follow-up was 40 months (range: 2.5 to 83 months). The disease-free survival rate was 67 percent (20/30), local failures occurred in 10 percent (3/30) of patients, and 23.3 percent (7/30) of patients either died or were lost to follow-up. Healing of radiation-induced wounds may be achieved using free-tissue transfers, but complications are frequent. Large-caliber irradiated vessels may be used to revascularize flaps, but there may be an increased risk of pedicle thrombosis.
本研究的目的是评估游离组织移植在修复放射性复合伤中的应用。对1988年5月至1995年11月在德克萨斯大学MD安德森癌症中心接受放射性损伤修复的患者病历进行了回顾性分析。纳入30例患者，共进行了33例游离皮瓣移植。放射性损伤缺损位于头颈部（n = 23）、四肢（n = 4）、胸壁（n = 2）和腹股沟区（n = 1）。放疗与损伤之间的平均间隔时间为78个月（范围：4个月至38年）。97%（32/33）的患者游离组织移植成功。总体并发症发生率为40%（12/30）。皮瓣供区包括腓骨（n = 12）、背阔肌（n = 6）、腹直肌（n = 6）、髂嵴（n = 4）、肩胛骨（n = 3）和桡侧前臂（n = 2）。颈部、腋窝或腹股沟区的大口径血管最常用于皮瓣再血管化。5例使用了静脉移植，其中2例用于动脉，3例用于静脉。位于放疗区域内的受体血管中有3例发生蒂血栓形成。2例皮瓣得以挽救，1例失败，该患者需要再次进行游离皮瓣重建。平均随访时间为40个月（范围：2.5至83个月）。无病生存率为67%（20/30），10%（3/30）的患者出现局部复发，23.3%（7/30）的患者死亡或失访。使用游离组织移植可实现放射性伤口的愈合，但并发症频发。大口径放疗血管可用于皮瓣再血管化，但蒂血栓形成风险可能增加。
