Complex Orofacial Reconstruction with the Intrinsic Chimeric Flap
Complex Orofacial Reconstruction with the Intrinsic Chimeric Flap
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DOI：
10.1055/s-0036-1597656
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发表时间：
2017-01
影响因子：
2.1
通讯作者：
A. Maldonado;Amanda K Silva;L. Humphries;L. Gottlieb
中科院分区：
文献类型：
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作者：
A. Maldonado;Amanda K Silva;L. Humphries;L. Gottlieb
摘要背景局部晚期或复发性头颈癌的消融通常会导致大的复合口面缺损，受体血管有限。这些复杂的缺损很适合于固有嵌合皮瓣重建，与复合皮瓣相比，嵌合皮瓣可以更好地插入各种皮瓣组成组织类型，并且只需要一组微血管重建。方法回顾性分析2002年至2015年使用自体嵌合游离皮瓣进行口面部重建的所有患者。只有一种组织类型的皮瓣，如两个单独的皮肤桨，没有额外的组件，不被认为是嵌合皮瓣，因此不包括在本报告中。分析患者的人口统计学数据、缺损和皮瓣特征以及并发症和结局，以创建皮瓣选择指南。进行单因素和多因素分析，以确定皮瓣收回和失败的危险因素。结果75例患者均行口面部固有型嵌合游离皮瓣修复。根据缺损特征组织结果，以创建皮瓣选择指南。嵌合体皮瓣的数量和手术时间与皮瓣的回收有独立的统计学相关性（p < 0.05）。有两个（3%）完全和五个（7%）部分皮瓣损失。平均随访时间为32.7个月。结论自体嵌合皮瓣为各种复杂的口面部缺损提供了一种灵活、美观的修复选择。我们提供了一个指南，以促进决策，在皮瓣选择这些具有挑战性的重建和报告的因素与皮瓣收回和损失。
Abstract Background Ablation of locally advanced or recurrent head and neck cancer often results in large composite orofacial defects with limited recipient vessels. These complex defects lend well to intrinsic chimeric flap reconstruction, which allows greater ability to inset various flap component tissue types than composite flaps and requires only one set of microvascular anastomoses. Methods A retrospective chart review was performed on all patients who underwent orofacial reconstruction with an intrinsic chimeric free flap from 2002 to 2015. Flaps with only one tissue type, such as two separate skin paddles with no additional component, were not considered chimeric flaps and therefore not included in this report. Patient demographic data, defect, and flap characteristics, as well as complications and outcomes were analyzed to create a guide for flap selection. Univariate and multivariate analysis was performed to determine risk factors for flap take-back and failure. Results Seventy-five patients underwent orofacial intrinsic chimeric free flap reconstruction. Results were organized based on defect characteristics to create a guide for flap selection. The number of chimeric flap components and operation duration were independently statistically associated with flap take-backs (p < 0.05). There were two (3%) total and five (7%) partial flap losses. Average follow-up time was 32.7 months. Conclusions Intrinsic chimeric flaps provide a versatile and elegant reconstructive option for a variety of complex orofacial defects. We provide a guide to facilitate decision making in flap selection for these challenging reconstructions and report factors associated with flap take-backs and losses.