带血管蒂小腿外侧皮瓣游离移植修复口腔颌面软组织缺损的临床研究

目的　评价带血管蒂小腿外侧皮瓣游离移植修复口腔颌面软组织缺损的临床应用价值。方法　1999年 11月~2002年12月对21例口腔颌面部肿瘤患者应用小腿外侧皮瓣游离移植修复其术后软组织缺损。手术采用血管吻合。其中7例为携带肌肉的肌皮瓣移植。采用游离小腿外侧皮瓣,最大12 cm×8 cm,最小5·0 cm×3·5 cm。结果　术后皮瓣20例成活,1例皮瓣坏死,皮瓣成活率为95·24%。术后19例颌面部外形恢复及张闭口语音功能达到满意或较为满意,1例因皮瓣面积不足,外形恢复欠佳。结论　带血管蒂的游离小腿外侧皮瓣具有血管蒂长、管径粗、组织量大、成活率高、供区隐蔽等优点,是口腔颌面部软组织缺损修复重建的最佳方法之一。     

游离腓骨肌皮瓣及CT血管造影术在下颌骨缺损重建中的应用

目的:探讨游离腓骨肌皮瓣及CT血管造影(CTA)技术在重建下颌骨缺损中应用。方法:10例下颌骨术后缺损拟行游离腓骨肌皮瓣重建,术前常规行下肢CTA检查,重建钛板预成形,进行游离腓骨肌皮瓣下颌骨重建。结果:术前CTA检查顺利,10例中1例胫后动脉缺如,腓动脉代替胫后动脉,放弃腓骨肌皮瓣重建。9例游离腓骨肌皮瓣均成活(成功率100%),下颌骨外形及功能满意。结论:腓骨肌皮瓣可提供足够软、硬组织量,是下颌骨复合缺损修复的较好供体;CTA技术在游离腓骨肌皮瓣重建下颌骨缺损术前供区评价选择、手术设计等方面具有很好的应用价值。     

口腔颌面部缺损游离皮瓣修复中血管吻合的技巧及关键点

血管吻合的质量是决定游离皮瓣移植修复术是否成功最为关键的因素。游离皮瓣在修复口腔颌面部缺损的应用中存在血管选择、受区血管相关术中表现和血管吻合技术等方面的诸多特点及技巧。同时,术后对皮瓣危象、并发症进行判断和处理时也有较多的关键点。笔者的团队在近年来开展了大量的口腔颌面缺损游离皮瓣修复,在口腔颌面颈部的血管吻合方面积累了大量的经验。本文针对口腔颌面缺损游离皮瓣修复中动静脉吻合的技巧、血管选择、血管危象的判断及处理等问题进行评述。     

头颈外科10年游离组织瓣移植经验:吻合2条静脉是否必需?

Ten-year experience of free flaps in head and neck surgery.How necessary is a second venous anastomosis?Ross GL,Ang ES,Lannon D,et al.Head Neck,2008,30(8):1086-1089.头颈部成功的游离组织瓣移植手术取决于动静脉的成功吻合。该文分析游离组织瓣移植成功的因素,确定吻合2条静脉的必要性。分析10年的头颈部恶性肿瘤术后应用游离组织瓣重建的经验。     

游离血管化复合组织瓣在口腔颌面部严重创伤性缺损畸形整复中的应用：11例临床分析

目的:探讨口腔颌面部严重创伤性缺损的显微重建特点及游离血管化组织瓣的临床应用效果。方法:回顾性分析福建医科大学附属第一医院口腔颌面外科2005—2018年收治的11例外伤致口腔颌面部组织严重缺损患者,均为复合型组织缺损,累及多个解剖区域（唇、颊、鼻、耳、颞部、颌骨等）,陈旧性损伤患者尚伴有严重的瘢痕形成及组织移位。全部病例采用游离血管化组织瓣进行修复,其中前臂皮瓣4例,腓骨肌皮瓣3例,侧胸皮瓣1例,股前外侧皮瓣3例。结果:11例患者均得到有效治疗,术后随访1~13 a,游离血管化组织瓣存活率100%。未发生皮瓣危象等并发症,10例患者对修复后面部外形和功能表示满意。结论:头颈外伤性缺损具有特殊性,显微外科技术在外形修复和功能重建中具有重要作用,尤其在局部邻近组织瓣无法完成修复的大型缺损中。精准评估伤情及软、硬组织缺损严重程度,选择合适的游离血管化组织瓣,是应用该技术取得良好疗效的关键。     

血管化游离组织瓣重建半舌切除后组织缺损:前臂桡侧皮瓣与股外侧皮瓣的功能评价

Microvascular free tissue transfer for tongue reconstruction after hemiglossectomy:a functional assessment of radial forearm versus anterolateral thigh flap.de Vicente JC,de Villalaín L,Torre A,Pea I.JOral Maxillofac Surg,2008,66(11):2270-2275.该文旨在比较舌癌患者应用前臂与股外侧皮瓣重建舌缺损后舌的功能及供区并发症差异。对2002年1月-2004年6月间的20例患者进行回顾性研究,所有患者均行半舌切除术,并行一期重建。     

对提高头颈部游离组织瓣移植成功率的探讨

目的：探讨如何提高头颈部游离组织瓣移植的成功率。方法：2004年1月至2004年12月间，由同一手术小组完成的连续194例患者的200块游离组织瓣移植．分析所采用组织瓣的类型、受区血管、游离瓣成活情况及术后并发症的发生情况，并探讨提高游离瓣可靠性的重要环节。结果：本组共采用7种游离瓣，包括腓骨瓣、前臂皮瓣、大腿前外侧皮瓣、空肠瓣、腹直肌皮瓣、肩胛瓣和背阔肌皮瓣。游离瓣的临床成功率为99．5％，术后血管危象的发生率为2％，抢救成功率为75％：受区和供区总并发症发生率为24．2％。结论：合理选择游离瓣、熟练的游离瓣制备技术、选择理想的受区血管、简化实用的血管吻合技术及游离瓣术后的有效监测，是提高头颈部游离瓣移植成功率的重要环节。如果各个环节处理得当。头颈部游离组织瓣移植的成功率应当接近100％。     

Outcomes of free flap reconstructive surgery in head and neck cancer patients over 80-years old

An increasing elderly population in the United Kingdom has led to an increasing number of older patients with head and neck cancer, resulting in a greater demand for complex head and neck reconstructive surgery in this potentially high-risk age group. A possible perceived poorer tolerance to such major treatment risks under-treating some of these patients. The purpose of this study was to assess the outcomes in the elderly population (older than 80 years) who had undergone free flap reconstruction following head and neck cancer resection. A retrospective review of 127 patients was performed. Eighteen patients were 80 or older (14.2%) and 109 under 80 (85.8%). The elderly group experienced increased number of postoperative medical complications (p = 0.01), but the surgical complications were not significantly different in the two groups (p = 0.4). The average length of hospital stay was significantly longer in the older group (p = 0.01). There was one flap failure during the study period, which belonged to the younger group of patients. Elderly patients undergoing free flap reconstruction experience an increased rate of postoperative medical complications resulting in an increased length of hospital stay. However, good surgical outcomes can still be achieved in this age group, and therefore age alone should not be considered as a primary factor in head and neck cancer management.     

Head and neck reconstruction in the vessel depleted neck using robot-assisted harvesting of the internal mammary vessels

We report a novel technique of robot-assisted harvesting of the internal mammary vessels to provide effective recipient vessels in a patient with bilateral vessel depleted neck (VDN). A 44-year-old with a Notani grade III osteoradionecrosis (ORN) of the anterior mandible underwent robot-assisted (Da Vinci® Surgical System, Intuitive Surgical) harvesting of the left internal mammary vessels (LIMA, LIMV). Reconstruction of the mandibular defect was done with a virtually planned composite fibular free flap and microvascular anastomosis of the peroneal vessels to the LIMA and LIMV. Successful reconstruction of the anterior mandible was achieved with excellent recipient arterial diameter and length, devoid of any significant thoracic morbidities resulting from robot-assisted harvesting of the internal mammary vessels. Robot-assisted harvesting of internal mammary vessels is a viable alternative to an open approach. The advantages in tissue handling, vessel length, and favourable profile of complications may extend the indications for this otherwise ‘niche’ solution in the VDN.     

Retrospective evaluation of diagnostic accuracy of free flap monitoring with the Cook-Swartz-Doppler probe in head and neck reconstruction

The Cook-Swartz-Doppler probe is an easy to handle and reliable tool for free flap monitoring. In the head and neck region different confounders can affect the read out. We therefore analyzed the use of the Doppler probe regarding these potential difficulties and to compare the diagnostic accuracy in arterial or venous monitoring of free flaps in the head and neck region.A retrospective study was performed in which all patients were included who underwent free flap surgery in the head and neck region in the Department of Plastic Surgery and the Department of Maxillofacial Surgery of our institution between 2010 and 2018 and were monitored with an implanted Doppler probe.147 free tissue transfers were included. No significance was found for arterial and venous placement of the Doppler probe for sensitivity (artery 83.3%; vein 84.6%; p = 0.87), specificity (artery 89.2%; vein 96.1%; p = 0.17) and negative predictive value (artery 96.7%; vein 94.2%; p = 0.55). A better positive predictive value for placing the Doppler probe around the artery (82.7%) than the vein (61.1%) was found in our study (p = 0.056).The better positive predictive value in arterial monitoring suggests that this is the more reliable measuring method to assess flap perfusion in the head and neck region.     

影响头颈部游离皮瓣移植成活的因素分析

目的：分析影响头颈部游离皮瓣移植成活的相关因素。方法：对我院2005.9—2009.11期间进行的124例游离皮瓣移植资料进行回顾,分析年龄,吸烟和（或）饮酒、手术技术及抗凝药物和扩血管药物等因素对游离皮瓣移植成功的影响。采用SPSS17.0软件包对数据进行连续性校正χ2检验和Fisher确切检验。结果：皮瓣移植的成功率为97.5%（121/124）,与手术技术有明显相关性,而与年龄、是否吸烟和（或）饮酒、是否有高血压和（或）糖尿病以及是否全身应用抗凝药物等无相关性;术后皮瓣危象发生率为4.0%（5/124）,静脉栓塞是主要原因（80%）,手术探查3例,抢救成功2例,成功率为66.7%。结论：精良的显微外科技术以及血管蒂的处理和保护是提高皮瓣游离移植成功率的关键,而性别、年龄、吸烟、饮酒及全身应用抗凝药物和扩张血管药物等均不是影响头颈部游离皮瓣移植成活的关键因素。     

21例儿童头颈部恶性肿瘤患者游离皮瓣修复临床分析

目的: 分析儿童头颈部肿瘤患者术区缺损游离皮瓣修复重建的临床特点。方法: 回顾2009—2011年于上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科接受头颈部恶性肿瘤切除以及游离皮瓣修复、年龄≤14岁患者的临床、病理及影像学资料。采用SPSS 17.0软件包对收集的数据进行统计学分析。结果: 最终纳入患者21例,其中男14例,女7例;17例为ASA Ⅰ级,4例为ASA Ⅱ级。中位手术时间480 min,中位术中出血量500 mL。6例患者接受气管切开。发生内科并发症7例,包括肺部感染4例,腹泻3例;外科并发症4例,包括皮瓣下血肿1例,创面裂开2例,腺瘘1例。气管切开术与内科并发症发生直接相关（P=0.035）,与总体并发症（P=0.064）发生具有潜在关联。结论: 游离皮瓣对于儿童头颈恶性肿瘤患者术区缺损修复具有极高价值,术后并发症是影响此类患者预后的主要负面因素,气管切开与术后并发症发生关系较大,需谨慎使用。     

Outcome and complications of 540 microvascular free flaps: the Hamburg experience

The aim of this study was to retrospectively analyze surgical outcome and complications of 540 free flap procedures performed at the Department of Oral and Maxillofacial Surgery of the University Medical Center Hamburg-Eppendorf during 1987–2005. A total of 532 patients were reconstructed with 540 flaps: 32% were latissimus dorsi flaps, 23% were radial forearm flaps, 21% were iliac crest flaps, 10% were fibula flaps, 6% were jejunal flaps, and 8% were other flaps. Thrombosis of one of the vessels and hematoma were the most frequent causes of failure in microvascular free tissue transfer. A total free flap failure occurred in 34 (6.2%) and a partial flap failure in 42 (7.7%) patients. The most reliable flap in regard to survival was the radial forearm flap. The present study confirms that free flaps are extremely reliable in achieving successful reconstruction of the head and neck. Pohlenz Philipp and Marco Blessmann contributed equally to this work.     

以颈横动脉供血的延长锁骨上岛状皮瓣修复头颈部恶性肿瘤术后缺损

应用于头颈部缺损修复的皮瓣多种多样,包括局部皮瓣、带蒂皮瓣和游离组织瓣。其中带蒂皮瓣具有容易切取、颜色及质地较好、手术时间短、并发症少等优点而被广泛应用。锁骨上区是一个重要的皮瓣供区,肩部皮肤提供了理想的可修复头颈外科缺损的皮肤组织。颈侧三角区主要的锁骨上血管是颈横动脉,目前罕有以颈横动脉供血的延长至肩部皮肤的锁骨上岛状皮瓣修复头颈部恶性肿瘤术后缺损的报道。本文对此方面内容作一评价。     

Effectiveness and safety of immediate application of negative pressure wound therapy in head and neck free flap reconstruction: a systematic review

To our knowledge this is the first systematic review of the immediate application of negative pressure wound therapy (NPWT) to the head and neck in free flap reconstruction. We conducted a systematic search of the PubMed and Cochrane databases in October 2021 using the MeSH terms ‘negative pressure wound therapy’, ‘free flaps’, ‘microsurgery’, and ‘vacuum-assisted closure’. Included studies evaluated the use of immediate NPWT in head and neck free flap reconstruction. Outcomes, indications, monitoring, and reported complications were retrieved. Of the 908 articles searched, nine published between 2000 and 2021 were included: four retrospective studies and five case series. NPWT was applied to 56 free flaps, and 54 had successful outcomes. The most common reported indication for flap reconstruction was malignancy. NPWT has the potential to be a valuable tool for complicated wounds, and further studies are needed to quantify functional and aesthetic outcomes.     

穿支皮瓣在口腔颌面-头颈部缺损重建的应用进展

穿支皮瓣是口腔颌面-头颈部软组织缺损修复的一项新技术,是显微外科的新发展。穿支皮瓣保留了供区的肌肉,明显减少了供区畸形的发生。但是穿支血管细小且存在变异,术前血管定位技术的应用和术中细致的显微血管解剖吻合技术是皮瓣移植成功的重要基础。本文对股前外侧皮瓣、腹壁下动脉穿支皮瓣和胸背动脉穿支皮瓣等常用穿支皮瓣在口腔颌面-头颈部缺损修复的应用进展予以综述。