Hand-Sewn Versus Microvascular Venous Anastomotic Coupler Device in Free Flap Reconstructions for Head and Neck Cancer ―― A Retrospective Study

靜脈接合使用傳統手縫和顯微血管環於頭頸癌之自由皮瓣重建之比較－回溯性研究

鄔逸群(Yi-Chun Wu) ； 林育賢(Yu-Hsien Lin) ； 林煌基(Huwang-Chi Lin) ； 鄭舉緒(Ju-Hsu Jeng) ； 陳柵君(Cha-Chun Chen) ； 林上熙(Shang-hsi Lin) ； 陳瑋農(Wei-Nung Jim Chen) ； 侯勝博(Sheng-Po Ho)

《臺灣整形外科醫學會雜誌》 26卷3期 (2017/09) Pp. 274-283

摘要

Background: Head and neck cancers pose a large threat to the people of Taiwan; such cases are usually reconstructed with a free flap after excision of the tumors. Head and neck reconstructions are especially challenging, considering the high rate of complications, such as infection or dehiscence due to the septic environment of the oral or nasal cavity. Microvascular anastomoses for free flap reconstructions are traditionally achieved by hand-suturing interrupted or continuous sutures along the vessel lumen. The procedure of hand-sewn vessel anastomosis is a time-consuming procedure, which leads to prolonged anesthesia, prolonged flap ischemic time, and increased physical fatigue for the surgeon. The microvascular venous anastomotic coupler system offers a solution for the above problems. Aim and objectives: We present our experience and results with free flap reconstruction after excision of head and neck cancers, comparing the outcome and complication rate of hand-sewn versus coupler venous anastomoses for head and neck cancers. Materials and methods: Between March 2011 and May 2016, a total of 209 patients, consisting of 201 male and 8 female patients, were included in this study retrospectively. The patients were divided into two groups: the Coupler group and the hand-sewn group according to whether the Coupler device was used for venous anastomosis. The patients were documented for past medical history, operative details, and post-operative outcomes. Results: All patient demographics showed no statistical difference between the hand-sewn and the Coupler group (p＞0.05). The average operative time of the hand-sewn group and the Coupler group was 449.8 minutes and 387.9 minutes, respectively, which shows a significant statistical difference (p ＜0.001). Compared to the traditional hand-sewn group, the Coupler system has a compatible rate of arterial thrombosis (0.9% vs. 1.1%, p=0.887), partial flap loss (5.2% vs. 5.3%, p=0.974), and total flap failure (2.6% vs. 3.2%, p=0.803). The venous thrombosis rate was lower in the Coupler group (0.9% vs. 4.2%, p=0.112). Flap dehiscence (11.30% vs. 7.5%, p=0.348), wound hematoma (7.8% vs. 4.3%, p=0.29), vessel kinking (1.7% vs. 0%, p=0.2), and wound infection (10.4% vs. 14.9%, p=0.334), all show no statistical difference between the two groups. The hospital admission time of both groups was not statistically different (p=0.288). Conclusion: The Coupler device offers a safe and reliable method for venous anastomoses with a compatible or even better rate of flap survival and venous patency, and at the same time greatly decreases the operation time by around 60 minutes.

關鍵字

reconstruction ； free flaps ； head and neck ； microvascular ； venous anastomotic device ； coupler ； venous coupler

並列摘要

背景：頭頸癌在台灣是一個嚴重的問題，一般這樣的病患在腫瘤切除之後都是使用自由皮瓣做重建。自由皮瓣使用在頭頸癌是一個很大的挑戰，一部分原因在於相對高的併發症機率以及口腔鼻腔的有菌環境。傳統上血管之接合採用顯微手術之下用手沿著血管壁做間斷性或連續性的縫合。這是一個耗時的步驟，也因此造成麻醉時間和皮瓣缺血時間延長、以及外科醫師更多的疲勞。顯微血管環對於上述問題便提供了一個改進的方法。目標：我們在此呈現頭頸癌切除後使用自由皮瓣重建之經驗和成果，以比較傳統手縫和使用血管環之併發症以及預後之差異。方法：手術時間介於2011年3月至2016年5月之間的209位病患，包含8位女性以及201位男性被納入這個回溯性研究之中。病患被分為兩組：血管環組以及手縫組，依據術中在靜脈接合時使用何種方法而定。紀錄內容包含過去病史、術中細節、及術後預後。結果：兩組病患之組成並無顯著差異(p值＞0.05)。平均手術時間於手縫組和血管環組分別為449.8分鐘和387.9分鐘，兩者之間有顯著差異(p值＜0.001)。和手縫組比較，血管環組有差異不大之動脈栓塞率(0.9%比上1.1%，p 值=0.887)、部分皮瓣損失率(5.2%比上5.3%，p值=0.947)、全皮瓣損失率(2.6%比上3.2%，p值=0.803)。靜脈栓塞率在血管環組比手縫組低(0.9%比上4.2%，p值=0.112)。皮瓣癒合不良率(11.30%比上7.5%，p值=0.348)、傷口血腫率(7.8%比上4.3%，p值=0.29)、血管扭結率 (1.7%比上0%，p值=0.2)、及傷口感染率(10.4%比上14.9%，p值=0.334)，皆無顯著差異。兩組之住院時間亦無顯著差異(p值=0.288)。結論：血管環在顯微靜脈接合方面提供一個更快且可靠的選項，對於靜脈暢通率以及皮瓣存活率和手縫比較都有差不多甚至更好之結果，並且同時讓手術時間縮短大約一小時。