O'Brien C J, Lee K K, Stern H S, Traynor S J, Bron L, Tew P J, Haghighi K S
Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Aust N Z J Surg. 1998 Oct;68(10):698-701. doi: 10.1111/j.1445-2197.1998.tb04654.x.
Microvascular free-tissue transfer is now the primary method of reconstruction in many centres. The aim of this study was to evaluate the applications, complications and limitations of free-flap reconstruction in a series of patients with tumours of the head and neck.
This study reviewed prospectively accessioned computerized records in a dedicated head and neck database. Patients treated between 1987 and 1995 with a minimum of a 1-year follow-up were reviewed. There were 242 patients with a mean age of 58 years (172 men and 70 women). The most common tumour sites were oral cavity (42%), oropharynx (32%) and hypopharynx (11%). Mucosal squamous carcinoma accounted for 87% of primary cancers.
Among the 250 free flaps, the radial forearm flap (205) and free jejunum (25) predominated. There were 21 episodes of vascular occlusion (8%), failure of 10 flaps (4%) and two patients died peri-operatively (0.8%). A second free flap was used in five of 10 cases of flap failure. The fistula rate was 4.4% among 203 patients at risk for this complication, which comprised four of 178 forearm flaps and five of 25 free jejunal grafts. Four of 16 jaw reconstructions failed.
A 96% success rate was achieved using free-tissue transfer for head and neck reconstruction. The overall complication rate was low but jaw reconstruction and free jejunal grafts posed the greatest problems because of failure of radial bone and fistulas, respectively. The radial forearm septocutaneous flap was very reliable and remains our mainstay for oral reconstruction.
在许多医疗中心，微血管游离组织移植如今是主要的重建方法。本研究的目的是评估一系列头颈部肿瘤患者游离皮瓣重建的应用、并发症及局限性。
本研究前瞻性地回顾了一个专门的头颈部数据库中录入的计算机化记录。对1987年至1995年间接受治疗且至少随访1年的患者进行了回顾。共有242例患者，平均年龄58岁（男性172例，女性70例）。最常见的肿瘤部位是口腔（42%）、口咽（32%）和下咽（11%）。黏膜鳞状癌占原发性癌症的87%。
在250例游离皮瓣中，桡侧前臂皮瓣（205例）和游离空肠（25例）占主导。发生血管闭塞21例（8%），10例皮瓣失败（4%），2例患者围手术期死亡（0.8%）。在10例皮瓣失败病例中的5例使用了第二个游离皮瓣。在203例有此并发症风险的患者中，瘘管发生率为4.4%，其中178例前臂皮瓣中有4例，25例游离空肠移植中有5例。16例下颌骨重建中有4例失败。
使用游离组织移植进行头颈部重建的成功率为96%。总体并发症发生率较低，但下颌骨重建和游离空肠移植分别因桡骨失败和瘘管问题带来了最大的难题。桡侧前臂皮下血管蒂皮瓣非常可靠，仍然是我们口腔重建的主要手段。
