Analysis of the Single and Double Venous Anastomosis for Free Flap Reconstruction after Head and Neck Cancer Operation-The Experience of Changhua Christian Hospital

頭頸癌患者游離皮瓣重建靜脈接合數量之手術資料分析－彰化基督教醫院經驗分享

張恩豪(En-Hao Chang) ； 謝明妤(Ming-Yu Hsieh) ； 張玉君(Yu-Jun Chang) ； 陳穆寬(Mu-Kuan Chen)

《台灣耳鼻喉頭頸外科雜誌》 54卷3期 (2019/09) Pp. 123-128

https://doi.org/10.6286/jtohns.201909_54(3).123

摘要

BACKGROUND: In cases of head and neck cancer, after a tumor-wide excision operation, the defect area requires an optimal flap reconstruction. The free flap reconstruction procedure requires either a one or two venous anastomosis, but the choice remains controversial. The aim of our study was to compare the surgical data and complications between one and two venous anastomosis. MATERIALS AND METHODS: A retrospective chart review was conducted for patients with head and neck cancer who underwent tumor wide excision between January 2016 and December 2017. The radial forearm free flap reconstruction was performed by the same microvascular surgeon from our Department of Otorhinolaryngology, Head and Neck Surgery at the Changhua Christian Hospital. Statistical analysis compared one and two venous anastomosis. RESULTS: Forty patients were included: twenty-five underwent one venous anastomosis and fifteen underwent two venous anastomosis. Only one patient, in the one venous anastomosis group, had a skin partial flap failure. Overall, no total flap failures occurred. The one venous anastomosis group had a statistically shorter ischemia time, but complications, admission days, and flap size showed no significant differences between the two groups. CONCLUSIONS: The one venous anastomosis should be considered the optimal treatment because it minimizes the duration and cost of surgery.

關鍵字

radial forearm free flap ； free flap venous anastomosis ； head and neck cancer postoperative reconstruction

並列摘要

背景：頭頸癌手術後大範圍的腫瘤切除後需要適合的皮瓣重建，而在學界中對於顯微游離皮瓣的靜脈接合數量需要一條或兩條是有所爭議的。本篇研究旨在比較兩組的手術資料以及相關併發症。材料及方法：以回顧性的方式審查彰化基督教醫院耳鼻喉暨頭頸部内2016年至2017年頭頸癌術後需要顯微游離皮瓣重建手術的病患，其中挑選出以橈側前臂皮瓣重建之個案，執行者為同一重建醫師，並且比較靜脈接合數量一條以及兩條的個案手術前中後的資料分析。結果：共有40名病患，其中有25名病患之游離皮瓣靜脈接合一條，15名病患游離皮瓣靜脈接合兩條。術後僅在一條血管組内有部分皮瓣表皮壞死情形，兩組皆無皮瓣整體壞死發生。統計分析發現接兩條血管的花費的時間統計上顯著比接一條的長；其餘在皮瓣大小、手術住院天數、以及術後併發症上，兩者並無統計學上的意義。結論：頭頸癌術後游離皮瓣重建接單條靜脈是合適的，可減少手術的時間，並且進一步的減少手術所需要的花費。

並列關鍵字

radial forearm free flap ； free flap venous anastomosis ； head and neck cancer postoperative reconstruction（橈側前臂皮瓣 ； 游離皮瓣靜脈接合 ； 頭頸癌術後重建）