Mast B A
Department of Surgery, University of Florida, Gainesville, USA.
Ann Plast Surg. 1999 Jan;42(1):40-5. doi: 10.1097/00000637-199901000-00007.
Treatment of large and/or invasive head and neck cancers results in defects that are complex, such that immediate free tissue transfer provides the best functional outcomes. Consequently, delayed use of free flaps in such patients is seldom seen in today's practice. The purpose of this study was to analyze a recent experience of such delayed microsurgical procedures to evaluate their efficacy and outcomes. Between November 1995 and May 1997, 13 patients underwent free flap reconstruction of residual or secondary defects following initial head and neck cancer ablation. Preoperative status was categorized as open wounds in 8 patients, oral incontinence in 9 patients, poor speech in 5 patients, and difficulty swallowing in 7 patients. Microvascular reconstruction was performed for the mandible and floor of the mouth/chin in 7 patients, cervical esophagus in 2 patients, sinus cavity in 2 patients, and one patient each underwent microvascular reconstruction of the orbit and cranial base. The free flaps utilized were fibular osteocutaneous (N = 6), radial forearm fasciocutaneous (N = 2), rectus abdominis (N = 2), jejunum (N = 1), radial forearm osteocutaneous (N = 1), and serratus (N = 1). There were no flap failures and the overall complication rate was 62%. Functional outcomes were best for the static conditions of open wound and oral incontinence, each demonstrating a 75% and 78% substantial improvement respectively. Conversely, functional improvement in dynamic functions such as poor speech and difficulty swallowing fared less well. Only 60% of patients with poor speech and 14% with difficulty swallowing showed significant improvement despite aggressive speech and swallowing therapy. These data show that the functional outcomes of free flap reconstruction of delayed head and neck cancer complications are inferior to those expected with immediate reconstruction using free tissue transfer. Nevertheless, reconstruction can be very useful with a high likelihood of flap survival and patient improvement.
大型和/或侵袭性头颈部癌症的治疗会导致复杂的缺损，因此即时游离组织移植能提供最佳的功能结果。所以，如今在这类患者中很少见到延迟使用游离皮瓣的情况。本研究的目的是分析近期此类延迟显微外科手术的经验，以评估其疗效和结果。1995年11月至1997年5月期间，13例患者在初次头颈部癌症切除后接受了游离皮瓣修复残余或继发性缺损。术前状况分类如下：8例为开放性伤口，9例为口腔失禁，5例为言语不佳，7例为吞咽困难。7例患者对下颌骨及口底/颏部进行了微血管重建，2例患者对颈段食管进行了微血管重建，2例患者对鼻窦腔进行了微血管重建，1例患者分别对眼眶和颅底进行了微血管重建。所使用的游离皮瓣包括腓骨骨皮瓣（N = 6）、桡侧前臂筋膜皮瓣（N = 2）、腹直肌皮瓣（N = 2）、空肠皮瓣（N = 1）、桡侧前臂骨皮瓣（N = 1）和锯肌皮瓣（N = 1）。没有皮瓣失败，总体并发症发生率为62%。对于开放性伤口和口腔失禁的静态状况，功能结果最佳，分别显示出75%和78%的显著改善。相反，言语不佳和吞咽困难等动态功能的改善情况较差。尽管进行了积极的言语和吞咽治疗，但只有60%言语不佳的患者和14%吞咽困难的患者显示出显著改善。这些数据表明，延迟头颈部癌症并发症的游离皮瓣重建的功能结果不如即时游离组织移植重建预期的结果。然而，重建仍可能非常有用，皮瓣存活和患者改善的可能性很高。
