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首页> 外文期刊>JAMA facial plastic surgery >Feasibility of Microvascular Head and Neck Reconstruction in the Setting of Calcified Arteriosclerosis of the Vascular Pedicle
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Feasibility of Microvascular Head and Neck Reconstruction in the Setting of Calcified Arteriosclerosis of the Vascular Pedicle

机译：微血管头部和颈部重建在血管椎弓根钙化动脉硬化的环境中的可行性

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摘要

Objective: To report outcomes in free flap reconstructive surgery in the setting of calcified arteriosclerosis affecting the flap pedicle. Design: Retrospective review, including a detailed analysis of medical records, histopathologic findings, and a comprehensive review of the literature. Methods: A total of 1329 consecutive microvascular free tissue transfers were performed by 2 reconstructive surgeons at a university-affiliated tertiary care medical center from January 1, 1996, through December 31, 2011. Clinical notes, operative notes, and pathology reports were systematically reviewed to identify 44 patients (3%) with calcified arteriosclerosis involving the flap vascular pedicle. A comprehensive medical record review was performed for the included patients, detailing patient-related characteristics, flap survival, and incidence of perioperative complications. Results: A history of arteriosclerosis was identified pre-operatively in 18 patients (41%). Eight patients (18%) were specifically recognized clinically and histologically to have a variant of arteriosclerosis known as Monckeberg medial calcific sclerosis. In total, fibula osteocutaneous free flap was performed in 30 patients, radial forearm in 8 patients, rectus abdominus in 3 patients, latissimus dorsi in 2 patients, and parascapular in 1 patient. Perioperative complications occurred in 17 patients (39%), with the most common being pulmonary (14%) and cardiac (9%). Patient follow-up ranged from 3 to 137 months, with a mean postoperative follow-up of 21 months. The mean length of hospital stay was 12 days. There was a 0% incidence of total flap failure and a 7% incidence of partial flap necrosis. Conclusion: Although technically challenging, successful microvascular free flap reconstruction can be achieved despite the presence of vascular calcifications affecting the flap vascular pedicle.
机译：目的：在影响皮瓣椎弓根的钙化动脉硬化设置中报告自由襟翼重建手术的结果。设计：回顾性评论，包括对病历，组织病理学发现的详细分析以及对文献的全面审查。方法：在1996年1月1日至2011年12月31日，在大学附属的第三级护理医疗中心，总共1329个连续的微血管自由组织转移进行了299年12月31日。系统地审查了临床票据，手术说明和病理报告鉴定44名患者（3％）钙化动脉硬化涉及襟翼血管椎弓鼠。对包括患者的患者进行了全面的医疗记录审查，详细说明患者相关的特征，皮瓣存活和围手术期并发症的发病率。结果：在18名患者中预先识别动脉硬化史（41％）。八名患者（18％）在临床上专门认识到临床和组织学上，以具有称为Monckeberg内膜钙化硬化的动脉硬化的变体。总共有腓骨骨科自由瓣在30名患者中进行，8名患者的桡骨前臂，3名患者的直肠腹部，2例患者的Latissimus Dorsi，1例患者。围手术期并发症发生在17名患者（39％）中发生，最常见的肺（14％）和心脏（9％）。患者随访3至137个月，平均术后随访21个月。住院住院的平均长度为12天。总皮瓣衰竭的发生率为0％，部分皮瓣坏死发病率为7％。结论：尽管在技术上挑战，尽管存在影响皮瓣血管椎弓集的血管钙化，但可以实现成功的微血管自由翼片重建。

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