Unsurpassed reliability of free flaps for head and neck reconstruction
Unsurpassed reliability of free flaps for head and neck reconstruction
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DOI：
10.1001/archotol.125.3.295
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发表时间：
1999-03-01
影响因子：
--
通讯作者：
Blackwell, KE
中科院分区：
文献类型：
--
作者：
Blackwell, KE
目的：回顾接受微血管游离皮瓣重建头颈部的患者的结果和围手术期并发症的发生率。设计：前瞻性病例系列。背景：学术三级护理耳鼻咽喉头颈外科项目。患者：115 名患者在 32 个月的时间内由 1 名外科医生连续进行 119 个游离皮瓣。干预措施：主要通过前臂桡骨、腓骨和直肌进行重建腹部皮瓣（95% 的皮瓣选择用于重建）。主要结果指标：围手术期重建和医疗并发症的发生率。结果：有 1 例围手术期死亡（0.8%）。存活患者中，有1例皮瓣完全失败，皮瓣总体存活率为99.2%。另有 2 例（1.8%）皮瓣部分坏死。 10.1% 的住院期间发生围手术期重建并发症，其中一半需要额外的手术干预。 17.1%的患者发生了明显的围手术期并发症。结论：尽管游离皮瓣的生存依赖于小血管吻合，但在皮瓣坏死的发生率方面非常可靠，这有助于降低围手术期并发症的发生率。选择经证明可靠的皮瓣有助于获得成功的结果。虽然这种技术通常需要对老年患者进行长时间的手术，但围手术期的死亡率和发病率是可以接受的。由于其无与伦比的可靠性，游离皮瓣已成为大多数头颈部严重缺损患者的首选重建方法。
Objective: To review the outcome and incidence of perioperative complications in patients undergoing microvascular free flaps for reconstruction of the head and neck region.Design: A prospective case series.Setting: An academic tertiary care otolaryngology-head and neck surgery program.Patients: One hundred fifteen patients who underwent 119 consecutive free flaps performed by 1 surgeon during a 32-month period.Interventions: Reconstruction primarily by means of radial forearm, fibula, and rectus abdominis flaps (95% of the flaps selected for reconstruction).Main Outcome Measure: The incidence of perioperative reconstructive and medical complications.Results: There was 1 perioperative death (0.8%). Among the surviving patients, there was 1 case of complete flap failure, resulting in an overall flap survival of 99.2%. There were 2 additional cases (1.8%) of partial flap necrosis. Perioperative reconstructive complications occurred during 10.1% of the hospitalizations, half of which required additional surgical intervention. Notable perioperative medical complications occurred in 17.1% of the patients.Conclusions: Despite their reliance on small-vessel anastomoses for survival, free flaps are extremely reliable with regard to the incidence of flap necrosis, which contributes to a low incidence of perioperative complications. Selection of flaps that have proven dependability contributes to a successful outcome. While this technique frequently requires lengthy surgery in an elderly patient population, the perioperative mortality and morbidity are acceptable. Because of their unsurpassed reliability, free flaps have become the preferred method of reconstruction for most patients with major defects in the head and neck region.