Serbest Flep ile Rekonstrükte Edilen Baş ve Boyun Defektlerinde Görülen Mikrovasküler Komplikasyonlar

Öz

Amaç: Baş ve boyun bölgesindeki defektlerin rekonstrüksiyonunda mikrocerrahi yöntem kullanma sıklığının artması ve buna bağlı olarak cerrahi deneyimde ilerleme gözlenmesi nedeniyle arter ve ven yetmezliğine bağlı revizyona alınan fleplerin oranında düşme gözlenmektedir, ancak kullanım sıklığının artması nedeniyle yetmezlik tespit edilen olgu sayısı artmaktadır. Çalışmanın amacı, baş ve boyun defektlerinde serbest flep kullanımından sonra görülen arteryal ve venöz yetmezlik nedenlerini saptamak ve serbest flep uygulanan hastaların revizyon üzerine demografik özelliklerini araştırmaktır. Gereç ve Yöntemler: 2013 ile 2016 yılları arasında baş boyun bölgesi defektlerinde serbest flep ile rekonstrüksiyon yapılan 72 hasta değerlendirildi. Ağız tabanı, dil kökü ve mandibula defektleri nedeniyle 26 hastaya; maksilla ve orbita gibi orta yüz defektleri nedeniyle 17 hastaya; dudak defektleri için 19 hastaya; frontal bölge gibi yüzün üst kısmı ve skalp defektleri nedeniyle 10 hastaya serbest flep yapıldı. 26 hastaya anterolateral uyluk ALT flebi; 22 hastaya fibula flebi; 14 hastaya latissimus dorsi flebi; 7 hastaya grasillis kas flebi; 1 hastaya jejenum flebi gerçekleştirildi. Bulgular: 66 hastanın flebi sorunsuz olarak iyileşti. 6 hastanın flebi arter veya ven yetmezliği nedeniyle revizyona alındı. İki hastanın flebinde total kayıp yaşandı. Bir hastanın flebinde parsiyel kayıp yaşandı.Sonuç: Serbest flep transferi sonrası dolaşım yetmezliği görülebilir. İyi takiplerle yetmezlikler erken dönemde fark edilerek yetmezliğe neden olan sorunlar ortadan kaldırılabilir. Baş ve boyun bölgesindeki geniş defektlerde fonksiyonel ve estetik sonuçları daha iyi olması nedeniyle serbest flepler ilk seçenek olarak gözönünde bulundurulmalıdır

Anahtar Kelimeler

• Baş ve boyun rekonstrüksiyonu, Serbest flep revizyonları, Mikrovasküler komplikasyonlar

Microvascular Complications in Head and Neck Defects Reconstructed with Free Flaps

Abstract

Objective: Because of increased frequency of use of microsurgical methods in head and neck defects, the number of cases in which insufficiency has been detected is going up, although the rate of revision due to arterial and venous insufficiency has decreased. The purpose of this study was to determine the causes of arterial and venous insufficiency after free flap used in head and neck defects and to investigate the effects of the demographic characteristics of the patients with free flaps on revision.Material and Methods: Between 2013 and 2016, 72 patients who were reconstructed with free flaps in the head and neck region defects were evaluated. 26 patients were reconstructed due to oral cavity, tongue root, and mandibular defects; 17 patients due to maxilla and orbital defects; 19 patients due to lip defects; and 10 patients due to problems related to the scalp and upper part of the face. 26 patients underwent anterolateral thigh ALT flap; 22 patients fibular flap; 14 patients latissimus dorsi flap; 7 patients gracilis muscle flap and 1 patient jejunal flap.Results: In 66 patients, recovery was completed without any problem. In 6 patients flaps were revised due to arterial or venous insufficiency. Total loss of two flaps and one partial flap necrosis were observed. Conclusion: Circulatory failure may occur after free flap transfer. With good follow-up, flap failures can be detected early and the problems that cause failure can be resolved. In wide head and neck defects, free flaps should be considered as the first choice because of the good functional and aesthetic results

Keywords

• Head and neck reconstruction, Free flap revisions, Microvascular complications

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