头颈外科二次游离重建受区血管选择：10年经验总结

目的：总结对头颈部进行二次游离重建受区血管的选择策略。方法：回顾分析2009年9月—2019年9月间中国医科大学附属口腔医院口腔颌面-头颈外科22例恶性肿瘤术后患者采用游离皮瓣二次重建头颈部缺损的经验,统计术中使用的受区血管、解剖时间以及吻合区与缺损区的距离等相关数据。结果：22例患者中,受区血管采用同侧颈部血管19例,其中颈横血管13例,颞浅血管3例,甲状腺上动脉+颈内静脉2例,面动脉+颈外、颈内静脉1例,对侧颈部血管3例,包括面动脉+颈内静脉2例,面动脉+颈内、颈外静脉1例。所有皮瓣完全成活且无明显并发症。结论：对于头颈外科术后需要二次游离皮瓣重建的病例,可首选颈横血管或颞浅血管作为受区血管。若两者不可用时,可打开未进行过手术的对侧颈部寻找理想受区血管;当对侧颈部也实施过颈淋巴清扫术和（或）放疗而无可用血管时,仔细探查同侧颈部解剖条件较好的血管以备吻合;而头静脉转位、静脉移植、乳内血管或胸肩峰血管等可作为最后的补救措施。

Selection strategy of recipient blood vessel during secondary free reconstruction in head and neck surgery: experiences over ten years

PURPOSE: To summarize the selection strategy of recipient blood vessel during secondary free reconstruction in head and neck surgery. METHODS: Between September 2009 and September 2019, 22 cases of secondary reconstruction of head and neck defects with free flaps were retrospectively analyzed, and relevant clinical data such as recipient blood vessels, anatomical time and distance between anastomosis area and defect area were summarized. RESULTS: Of the 22 cases, 19 underwent harvesting of ipsilateral neck blood vessels in the recipient region, including 13 transverse cervical vessels, 3 superficial temporal vessels, 2 superior thyroid artery and internal jugular vein, 1 facial artery and internal and external jugular vein; 3 patients underwent harvesting of contralateral neck blood vessels in the recipient region, including 2 from facial artery and internal jugular vein, 1 from facial artery and internal and external jugular vein. All flaps survived without obvious complications. COUCLUSIONS: Transverse cervical vessels or superficial temporal vessels should be the first choice for the recipient vessels during secondary free flap reconstruction after head and neck surgery. If neither is possible, the unoperated contralateral neck can be opened to find the ideal recipient vessels. When no blood vessels are available after neck dissection and/or radiotherapy of contralateral neck, the ipsilateral neck blood vessels with good quality should be carefully explored for anastomosis. Cephalic vein transposition, vein transplantation, intramammary vessels or pectoral acromial vessels may be used as the last resort.