Autonomization of free flaps in the oral cavity: A prospective clinical study
Autonomization of free flaps in the oral cavity: A prospective clinical study
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DOI：
10.1002/micr.20984
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发表时间：
2012-03-01
期刊：
影响因子：
2.1
通讯作者：
Steiner, Timm
中科院分区：
文献类型：
--
作者：
Muecke, Thomas;Wolff, Klaus-D.;Steiner, Timm
关于自由皮瓣依赖于其蒂的时间长短，以及皮瓣类型、受体位置、辐照和未辐照患者的新生血管形成是否不同，存在争议。了解这一过程的时机可以优化涉及皮瓣的二次手术的安全性。在一项前瞻性临床研究中，我们测量了50个皮瓣（25个前臂皮瓣，15个腓骨皮皮瓣和10个大腿前外侧皮瓣）术后4周和12周的血红蛋白氧合和毛细血管流量。皮瓣位于口腔底部、脸颊或舌头（n = 39）或硬腭或软腭（n = 11）。使用O2C监测系统在椎弓根暂时手指闭塞的情况下进行测量。4周后，通过比较数字压迫血管蒂前后的O2C测量值，发现17个游离皮瓣自主。12周后，41例患者完成自由皮瓣自主化，通过椎弓根压迫前后的HbO2和CF显示。下颌游离皮瓣位置（4周后P < 0.0001, 12周后P = 0.013）、前臂桡侧筋膜皮皮瓣位置（4周后P < 0.0001）、4周后未照射受体部位（P = 0.014）是影响自主神经功能的积极因素。综上所述，自由皮瓣的自主化取决于几个变量，在自由皮瓣重建后的进一步手术前应考虑这些变量，因为转移的组织仍然依赖于其蒂。(C) 2012 Wiley期刊公司显微手术,2012年。
Controversy exists over how long a free flap is dependent on its pedicle and if neovascularization is different between flap types, recipient sites, and irradiated and nonirradiated patients. An understanding of the timing of this process should optimize the safety of secondary procedures involving the flap. In a prospective clinical study, hemoglobin oxygenation and capillary flow were measured in 50 flaps (25 forearm flaps, 15 osteocutaneous fibula flaps, and 10 anterolateral thigh flaps) 4 and 12 weeks postoperatively. The flaps were located at the floor of the mouth, cheek, or tongue (n = 39) or at the hard or soft palate (n = 11). Measurements were carried out using the O2C monitoring system under temporary digital occlusion of the pedicle. After 4 weeks, 17 free flaps were found to be autonomized indicated by the O2C measurements comparing both values before and after digital compression of the vascular pedicle. After 12 weeks, 41 patients had completion of free flap autonomization, as indicated by the HbO2 and CF before and after pedicle compression. The location of free flap in the lower jaw (P < 0.0001 after 4 weeks, P = 0.013 after 12 weeks), fasciocutaneous radial forearm flaps after 4 weeks (P < 0.0001), and not irradiated recipient site after 4 weeks (P = 0.014) were found to be positive factors significantly influencing autonomization. In conclusion, free flap autonomization depends on several variables which should be considered before further surgery after free flap reconstruction as the transferred tissue can be still dependent on its pedicle. (C) 2012 Wiley Periodicals, Inc. Microsurgery, 2012.