Microvascular Flap Reconstruction after the Head and Neck Tumor Resections: A Review of 10 Years NTUH Experience

台大醫院十年之經驗：血管顯微皮瓣重建手術於頭頸部腫瘤切除後的應用

阮廷倫(Tyng-Luen Roan) ； 林明賢(Ming-Hsien Lin) ； 李兆翔(Chao-Hsiang Lee) ； 洪學義(Shyue-Yih Horng) ； 謝榮賢(Jung-Hsien Hsieh) ； 戴浩志(Hao-Chih Tai) ； 湯月碧(Yueh-Bih Tang)

《臺灣整形外科醫學會雜誌》 19卷3期 (2010/09) Pp. 199-208

https://doi.org/10.7096/TJTSPS.201009.0199

摘要

背景：
使用游離皮瓣做爲頭頸部腫瘤切除後的術後重建，已被公認是目前的治療首選。理想的游離皮瓣須包含以下幾點：在設計上富有多變性(versatility)、足夠的組織容量、較佳的質地(texture)、有較大且較長的莖(pedicle)、皮瓣的解剖學一致性高且取得容易、供應皮瓣處的併發症越少越好、能兩組團隊同時進行手術。
目的及目標：
這篇文章是要呈現台大醫院，從西元1997年至2006年，十年期間使用顯微皮瓣手術在頭頸部腫瘤術後重建的統計資料和成果分析。
材料及方法：
我們以病歷回溯方式，蒐集台大醫院於1997年1月至2006年12月間，共有575位病人進行642次頭頸部腫瘤切除後的顯微游離皮瓣重建手術，針對國人頭頸部腫瘤好發位置，游離皮瓣的選擇及手術結果進行分析。
結果：
在這個研究中有537位男性及38位女性，平均手術年齡爲51.5歲。有511位病人接受1次顯微重建手術，61位病人接受過2次以及3位病人接受過3次手術。頭頸部病灶切除的病因以惡性腫瘤爲主(98%)。我們發現國人頭頸部的腫瘤以鱗狀細胞癌最常見，好發位置依序分別爲頰處(50%)、舌頭(17%)及牙齦(11%)。游離皮瓣的選擇以大腿前外側皮瓣(ALT flap)爲主(61%)，其次爲腓骨瓣(fibular flap)(22%)，再其次爲橈前臂皮瓣(radial forearm flap)。此系列的顯微游離皮瓣重建手術成功率爲95.6%。共有64位病人須接受再次探查手術，比例爲10%，其中皮瓣搶救存活率爲56%。
結論：
顯微游離皮瓣重建手術用在頭頸部腫瘤切除後重建是一種安全且可行的方式，其中又以大腿前外側游離皮瓣最常被使用。此系列的顯微游離皮瓣重建手術成功率爲95.6%。結果和其他國際大型研究相當。

並列摘要

Background:
In the past 10 years, microvascular free flaps have become the gold standard for reconstruction of head and neck defects after tumor resection. Ideal flaps for head and neck reconstruction should fulfill the following criteria: versatility in design, adequate tissue volume, superior texture, availability of diverse tissue types on one pedicle, potential for re-innervations, large and long pedicle with consistent anatomy, easy and safe flap dissection, feasibility of a two-team approach, and negligible donor site morbidity. Simplification of flap selection for head and neck reconstruction has been a recent trend.
Aim and Objectives:
This study presents a single center experience with head and neck reconstruction using a free flap and describes the morbidity of the flap.
Materials and Methods:
All free microvascular reconstructions after head and neck tumor resections during the period from January 1997 to December 2006 were retrieved from this hospital's database and analyzed with regard to surgical defect, chosen donor site and complications. Results:
From January, 1997 to December, 2006, we performed 642 free flap reconstructions from various donor sites for 575 patients. The anterolateral thigh flap was done in 394 reconstructions (61%); the radial forearm flap in 141 reconstructions (22%); and the fibula flap in 78 reconstructions (12.1%). Among these reconstructions, 26% of the donor sites were closed primarily. Surgical re-exploration was necessary in 64 reconstructions (10%). The flap success rate is 95.6% in this series.
Conclusion:
This study using free flaps after radical surgery shows a success rate of 95.6%, which is compatible to other series. Immediate repair of head and neck defects using free flap is a successful and reliable method and is becoming the gold standard in our hospital.

並列關鍵字

head and neck ； free flap ； microvascular reconstruction