545块头颈部游离组织瓣移植的临床分析

A review of 545 consecutive free flap transfers for head and neck reconstruction in a new microsurgery unit

目的 探讨游离组织瓣移植在头颈部缺损修复中的应用价值。方法 1999年 5月～2 0 0 2年 9月由同一手术小组完成的连续 5 0 7例患者的 5 45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 ,并分析有可能影响游离瓣成活的各种因素。结果 腓骨瓣、前臂皮瓣和腹直肌皮瓣为最常用的 3种游离组织瓣 ,占全部游离瓣的 96 0 %(5 2 3 / 5 45 ) ;游离瓣的临床成功率为 98 2 % (5 3 5 / 5 45 ) ,术后血栓的发生率为 4 8% (2 6/ 5 45 ) ,抢救成功率为 61 5 % (16/ 2 6) ;受区和供区总的并发症发生率为 2 5 2 % (12 8/ 5 0 7) ,但大多数并发症均不严重 ,没有造成严重的后果 ;吸烟、饮酒、放射治疗和年龄 (高龄和儿童 )等均非影响游离组织瓣移植成功的重要因素。结论 头颈部游离组织瓣移植安全可靠 ,其明显优于传统的带蒂组织瓣移植 。

Objective To analyze the value of free flap transfers in head and neck reconstruction Methods Five hundred and forty five consecutive free flap transfers performed in 507 patients from May 1999 to September 2002 were reviewed Data concerning the operation included date of surgery, defect description and site, stage and histology of tumor, flap type, recipient vessel and complications Results The free fibula flap was most commonly used, followed by free radial forearm flap, rectus abdominis flap, jejunum flap, scapular flap, illiac crest flap, latissimus dorsi flap, and anterolateral thigh flap The overall success rate of flap was 98 2%(535/545) The overall complication rate was 25 2%(128/507) The vessel thrombosis rate was 4 8%(26/545), and the flap salvage rate was 61 5%(16/26) Conclusion Free flap transfer in head and neck region is safe and reliable It is superior to the conventional pedicled flap technique