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

Yıl 2017, Cilt: 3 Sayı: 1, 15 - 24, 01.01.2017

Özlenen Özkan Mehmet Can Ubur Neslihan Yaprak Alper Tunga Derin Ömer Özkan

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

Öz

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

Anahtar Kelimeler

Head and neck reconstruction, Free flap revisions, Microvascular complications

Kaynakça

• Daniel RK, Taylor GI, Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg, 1973; 52(2): 111-7.
• Wells MD, Luce EA, Edwards AL, Vasconez HC, Sadove RC, Bouzaglou S. Sequentially linked free flaps in head and neck reconstruction. Clin Plast Surg 1994; 21(1): 59-67.
• Schusterman MA, Miller MJ, Reece GP, Kroll SS, Marchi M, Goepfert H. A single center's experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg, 1994; 93(3):472-8; discussion 479-80.
• Ozkan, O, Ozgentas HE, Dikici MB, Simultaneous reconstruction of large maxillary and mandibular defects with a fibular osteocutaneous flap combined with an anterolateral thigh flap. J Reconstr Microsurg, 2004; 20(6): 451-5.
• Parrett BM, Pomahac B, Orgill DP, Pribaz JJ. The role of free-tissue transfer for head and neck burn reconstruction. Plast Reconstr Surg, 2007; 120(7): 1871-8.
• Hu J, Yin L, Tang X, Gui L, Zhang Z. Combined skeletal and soft tissue reconstruction for severe Parry-Romberg syndrome. J Craniofac Surg, 2011; 22(3): 937-41.
• Chaput B, Vergez S, Somda S, Mojallal A, Riot S, Vairel, B., Meresse T, Garrido I, Grolleau JL, de Bonnecaze G. Comparison of single and double venous anastomoses in head and neck oncologic reconstruction using free flaps: A meta-analysis. Plast Reconstr Surg 2016. 137(5): 1583-94.
• Corbitt C, Vergez S, Somda S, Mojallal A, Riot S, Vairel B, Meresse T, Garrido I, Grolleau JL, de Bonnecaze G. Free flap failure in head and neck reconstruction. Head Neck 2014; 36(10): 1440-5.
• Zhang C, Sun J, Zhu H, Xu L, Ji T, He Y, Yang W, Hu Y, Yang X, Zhang Z. Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps. Int J Oral Maxillofac Surg 2015; 44(6): 675-84.
• Xu Z, Zhao XP, Yan TL, Wang M, Wang L, Wu HJ, Shang ZJ. A 10-year retrospective study of free anterolateral thigh flap application in 872 head and neck tumour cases. Int J Oral Maxillofac Surg 2015; 44(9): 1088-94.
• Eser C, Eser Ş, Gencel E, Altun E, Aslaner EF, Biçer A. Is the preoperative MPV value related to early thrombus formation in microvascular anastomosis? J Plast Surg Hand Surg 2016; 50(5): 298-301.
• oral cavity cancers. Head Neck 2009; 31(10): 1289-96.
• Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109(7): 2219-26; discussion 2227-30.
• Jones NF, Vögelin E, Markowitz BL, Watson JP. Reconstruction of composite through-and-through mandibular defects with a double-skin paddle fibular osteocutaneous flap. Plast Reconstr Surg 2003; 112(3): 758-65.
• Ozkan O, Ozkan O, Derin AT, Bektas G, Cinpolat A, Duymaz A, Mardini S, Cigna E, Chen HC et al. True functional reconstruction of total or subtotal glossectomy defects using a chimeric anterolateral thigh flap with both sensorial and motor innervation. Ann Plast Surg 2015; 74(5): 557-64.
• Ozkan, O, Coskunfirat OK, Ozgentas HE, Derin A et al. Rationale for reconstruction of large scalp defects using the anterolateral thigh flap: Structural and aesthetic outcomes. J Reconstr Microsurg 2005; 21(8): 539-45.
• Jones NF, Hardesty RA, Swartz WM, Ramasastry SS, Heckler FR, Newton ED. Extensive and complex defects of the scalp, middle third of the face, and palate: The role of microsurgical reconstruction. Plast Reconstr Surg 1988; 82(6): 937-52.
• Ozkan O, Ozkan O, Bektas G, Cinpolat A, Erdogan O, Sanli S, Yilmaz M. Subcutaneous placement of a free jejunum and pedicled colon segment to create a diversionary conduit for total esophageal reconstruction. Microsurgery 2012; 32(3): 235-9.
• Ozkan O, Chen HC, Cigna E, Mardini S, Salgado CJ, Lai HK, Liu YT. Intussusception of a transferred jejunal flap in cervical esophagus reconstruction. Ann Plast Surg 2005; 55(3): 327-9.
• Ozkan O, Özkan Ö, Amoroso M. Temporary Banking of the jejunal flap for a difficult esophageal reconstruction. Ann Thorac Surg 2017; 103(1): e1-e3.
• Jones NF, Jarrahy R, Song JI, Kaufman MR, Markowitz B. Postoperative medical complications-not microsurgical complications-negatively influence the morbidity, mortality, and true costs after microsurgical reconstruction for head and neck cancer. Plast Reconstr Surg 2007; 119(7): 2053-60.
• Choi S, Schwartz DL, Farwell DG, Austin-Seymour M, Futran N. Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer. Arch Otolaryngol Head Neck Surg 2004; 130(11): 1308-12.