Free Flap Surgery is one of Effective Ways for Mandibular Osteoradionecrosis Reconstruction

運用有效益之顯微游離皮瓣重建手術於下顎骨放射性骨壞死之經驗分享

黃重崴(Jong-Wei Huang) ； 蒲啟明(Chi-Ming Pu) ； 顏毓秀(Yu-Hsiu Yen)

《臺灣整形外科醫學會雜誌》 26卷4期 (2017/12) Pp. 396-405

摘要

Background: Osteoradionecrosis is a severe complication of radiation therapy, and results in a chronic non-healing wound, pain, trismus, and reduced the quality of life. Marx summarized the stages and treatment of osteoradionecrosis decades ago. However, the protocols have changed. The management of osteoradionecrosis includes conservative treatment, antibiotics, hyperbaric oxygen therapy, or surgical intervention. Radical resection of necrotic tissue and reconstruction with free vascularized tissue have become a common treatment. Aim and Objectives: In this report, we describe our experience with osteoradionecrosis in patients after treatment of head and neck cancer, and discuss the cost-effectiveness of surgical management and conservative treatments reported in the literature. Materials and Methods: A retrospective review was included in eight patients with osteoradionecrosis treated by the senior surgeon (C-M P.) at our institution from January 2010 to December 2015. Patient's symptoms, radiologic images, and medical record data were collected. All patients underwent radical segmental mandibulectomy and reconstruction with a free flap. No patients received hyperbaric oxygen treatment. The surgical procedures, surgical findings, outcomes, and complications were recorded in detail. Results: Data from eight patients were collected. All were men aged between 40 and 75 years. The mean time interval before development of osteoradionecrosis was approximately one year (8 to 20 months). Six free fibular flaps and two anterolateral thigh flaps were used to reconstruct the defect necessitated by segmental resection of the mandible. All but one flap survived. Significant postoperative improvement was noted. The mean clinical follow-up period was about three years. Conclusions: Free vascularized tissue reconstruction of a defect caused by radical mandibular resection for osteoradionecrosis was effective and safe. The successful rate was high, and the positive outcome improved the quality of life. We advocate simultaneous sequestrum resection with microvascular flap reconstruction, especially with the use of a fibular flap, to manage complications after radiotherapy.

關鍵字

osteoradionecrosis ； free flap reconstruction ； cost-effective ； head and neck cancer

並列摘要

背　景：頭頸部惡性腫瘤經放射線治療後造成之下顎骨放射性骨壞死是一嚴重併發症。目前是應用保守性治療來面對放射性骨壞死此併發症，例如：保持口腔清潔、適當的抗生素、甚至高壓氧治療。然而，保守性治療常是不足夠的。病患仍須接受根治性下顎骨切除手術並且以游離皮瓣手術予以重建。目的及目標：我們將分享經驗和討論手術及保守性治療的效率及效益考量。材料及方法：自2010年至2015年共有八位頭頸部惡性腫瘤病患經手術及放射性治療後發生下顎骨放射性骨壞死之併發症。病歷、影像皆回溯回顧。全部病患未經高壓氧治療，均接受根治性骨壞死切除手術及施以顯微游離皮瓣重建手術。游離皮瓣之選擇、手術細節及手術後之併發症均詳細記錄。結　果：八位下顎骨放射性骨壞死病患接受根治性切除及游離皮瓣重建手術。病患平均年齡為54歲。六位接受腓骨游離皮瓣及兩位接受前外側大腿游離皮瓣重建。一位病患歷經皮瓣壞死，於清創後施以胸大肌皮瓣手術。術後追蹤平均約三年半，無腫瘤復發之情形，其口腔功能改善，且對重建後外觀感到滿意。結　論：對於下顎骨放射性骨壞死之病患，施以根治性下顎骨死骨切除併顯微游離皮瓣，其手術安全且預後良好。游離皮瓣手術成功率高，可為頭頸部惡性腫瘤接受放射線治療導致放射性骨壞死之病患提供有效率及效益之治療方式。