Microsurgical Free Flap Reconstructions of Head and Neck Region in 406 Cases: A 13-Year Experience
Microsurgical Free Flap Reconstructions of Head and Neck Region in 406 Cases: A 13-Year Experience
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DOI：
10.1016/j.joms.2012.07.002
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发表时间：
2013-03-01
影响因子：
1.9
通讯作者：
Ghassemi, Alireza
中科院分区：
文献类型：
--
作者：
Gerressen, Marcus;Pastaschek, Claudia Inge;Ghassemi, Alireza
目的：应用显微外科皮瓣修复颌面部大面积软组织及骨缺损是首选的治疗方法。本研究旨在探讨影响皮瓣存活的各种因素。材料和方法：我们分析了1998年至2010年间在我院接受显微外科皮瓣重建的406例患者的资料（女性121例，男性285例，平均年龄57岁）。本组共检查软组织皮瓣326个（前臂桡侧皮瓣、肩胛骨皮瓣、背阔肌皮瓣、股前外侧皮瓣、臂外侧皮瓣和空肠皮瓣）和骨皮瓣80个（腓骨皮瓣和旋髂深动脉皮瓣）。评估的参数包括重建时间、缺陷定位、使用的受体血管（外颈vs内颈系统）以及抗凝管理。我们采用chi(2)检验对数据进行统计分析，考虑到比值比P < 0.05，认为差异有统计学意义。结果：皮瓣总存活率约为92%，无性别和年龄差异。一期重建明显优于二期重建（P < 0.01）。同样，缺损定位对皮瓣成活率也有显著影响（P = 0.01），更尾端定位对皮瓣成活率有积极影响。最后，抗凝治疗方案和受体静脉系统的选择对存活率都没有影响。结论：在了解成功因素的前提下，显微外科组织移植是一种方便、可靠的颌面外科手术方法。[C] 2013中华口腔颌面外科杂志[J] .中华口腔颌面外科杂志，31 (1):628-635,2013
Purpose: The reconstruction of extended soft tissue and bony defects in the maxillofacial region with microsurgical flaps is considered to be the therapy of first choice. The aim of this retrospective study was to detect different influencing factors concerning flap survival.Materials and Methods: We examined the data of 406 patient cases (121 female and 285 male cases; mean age, 57 years) undergoing reconstruction with a microsurgical flap in our facility between 1998 and 2010. In these cases 326 soft tissue flaps (radial forearm flap, scapula flap, latissimus dorsi flap, anterolateral thigh flap, lateral arm flap, and jejunum flap) and 80 bony flaps (fibula flap and deep circumflex iliac artery flap) were examined. Evaluated parameters were, among others, the timing of reconstruction, defect localization, and recipient vessels used (external vs internal jugular system), as well as anticoagulative management. We statistically analyzed data by means of a chi(2) test, taking account of the odds ratio with P < .05, which was deemed significant.Results: The overall flap survival rate was approximately 92%, without any gender-or age-specific differences. Primary reconstructions proceeded distinctly more successfully than secondary reconstructions (P < .01). Likewise, the defect localization exerted a significant effect on the survival rate (P = .01), with a more caudal localization affecting flap survival positively. Finally, neither the anticoagulation regimen nor the choice of recipient vein system exercised an influence on the survival rate.Conclusions: Microsurgical tissue transfer is a convenient and reliable method in maxillofacial surgery, provided that one is aware of the determining factors for success. (C) 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 71:628-635, 2013