Management of large head and neck defects in the vessel-depleted neck.

IF 1.9 4区 医学 Q2 OTORHINOLARYNGOLOGY
Lindsey Shehee, Danielle Bottalico, Brandon Prendes
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引用次数: 0

Abstract

Purpose of review: Surgery, radiation, and chemotherapy are often utilized in the treatment of head and neck cancer. These treatments can cause extensive scarring within the neck and can limit the viability of recipient vessels for further microvascular reconstruction. Patients with vessel-depleted necks provide a significant challenge for microvascular surgeons and are a topic of much discussion in the field.

Recent findings: While reconstruction in the vessel-depleted neck is an active area of interest, the patient population is rare. Therefore, single institution series with small numbers comprise the majority of published literature. Recent publications describe techniques for identifying adequate recipient vessel options outside of the field of treatment with excellent free flap outcomes. Further, recent summary articles describe techniques for addressing issues with pedicle length that can arise when using vessels that are far from the defect to be reconstructed.

Summary: When viable vessel options are available within the treatment field, these recipient vessels can be used with good reliability and free flap success. If in-field recipient vessels are not available, minimal access incisions can be used to identify superficial temporal, angular, contralateral facial, or transverse cervical vessels. Further away from the treatment field, internal mammary vessels can be harvested through open or robotic approaches. If the use of these distant vessels creates issues with pedicle length, interposition vein grafts, arteriovenous (AV) loops, or flow-through flaps can be used to augment vessel length.

处理颈部血管缺损的巨大头颈部缺损。
审查目的:头颈部癌症的治疗通常采用手术、放疗和化疗。这些治疗方法会在颈部造成广泛的瘢痕,并会限制受体血管进一步进行微血管重建的可行性。颈部血管缺损患者给微血管外科医生带来了巨大挑战,也是该领域讨论较多的话题:最近的研究结果:虽然颈部血管缺损的重建是一个备受关注的领域,但这种患者却很少见。因此,在已发表的文献中,大多数都是单个机构的小样本病例。最近发表的文章介绍了在治疗区域外寻找足够受体血管的技术,并取得了很好的游离皮瓣效果。此外,最近的总结性文章介绍了如何解决在使用远离待重建缺损的血管时可能出现的瓣蒂长度问题的技术。如果没有治疗区域内的受体血管,可以使用最小切口来确定颞浅血管、角血管、对侧面部血管或颈横血管。在距离治疗区域更远的地方,可以通过开放式或机器人方法采集乳腺内血管。如果使用这些远处的血管会造成血管蒂长度的问题,则可以使用插位静脉移植、动静脉环或穿流皮瓣来增加血管长度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
96
审稿时长
6-12 weeks
期刊介绍: Current Opinion in Otolaryngology & Head and Neck Surgery is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With eleven disciplines published across the year – including maxillofacial surgery, head and neck oncology and speech therapy and rehabilitation – every issue also contains annotated references detailing the merits of the most important papers.
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