背景和目的:晚期头颈部肿瘤患者需要抢救手术作为最后的手段。这些广泛的手术带来了复杂重建的挑战。处理这种复杂病例的头颈部外科医生需要掌握不同的皮瓣。管理这些患者的团队需要各种专家的意见,还有耳鼻喉科医生,整形外科医生,颌面外科医生,血管外科医生,经验丰富的放射科医生,专门的病理学家,肿瘤学家和放射治疗师。我们专注于肿瘤切除与患者未来生活质量和总体生存率之间的最佳解决方案。每个复杂的病例都需要个性化的医疗方法。这项范围审查旨在评估使用各种皮瓣治疗头颈部肿瘤的复杂重建的疗效和结果。专注于自由皮瓣和新兴技术。材料和方法:遵循PRISMA指南对文献进行了系统的搜索,结果在过去10年中纳入了44条符合预定标准的条款。结果:纳入的研究涵盖了不同的患者人群,并评估了各种手术技术,结果,并发症,以及头颈部重建的进步。该综述确定了头颈部肿瘤重建中使用的各种皮瓣,包括游离皮瓣,如桡骨前臂,大腿前外侧,肩胛骨尖端,和肌皮瓣,在其他人中。游离皮瓣重建的成功率从85%到100%不等,与患者选择的显著差异,肿瘤特征,和外科专业知识。结论:皮瓣坏死等并发症,感染,血肿,供体部位的发病率在整个研究中都有记录,强调细致的手术计划和术后护理的重要性。此外,审查揭示了计算机辅助设计等新兴技术,虚拟手术,立体光刻模型,定制植入物,组织工程,和同种异体移植,提供有希望的重建设备。外科技术和新兴技术的进步有望进一步增强重建结果,将发病率降至最低,提高患者的生活质量。
Background and Objectives: Patients with advanced head and neck tumors require salvage surgery as a last resort. These extensive surgeries pose the challenge of complex reconstructions. The head and neck surgeon undertaking such complex cases needs to master different flaps. The team managing these patients needs input from various specialists, along with otorhinolaryngologists, plastic surgeons, maxillofacial surgeons, vascular surgeons, experienced radiologists, dedicated pathologists, oncologists and radiation therapists. We focus on the optimum solution between oncologic resections and the future quality of life of patients and overall survival. Each complex case requires a personalized medicine approach. This scoping
review aims to assess the efficacy and outcomes of complex reconstructions using various flaps for head and neck tumors, with a focus on free flaps and emerging techniques. Materials and Methods: A systematic search of the literature was conducted following PRISMA guidelines, resulting in the inclusion of 44 articles that met the predefined criteria in the last 10 years. Results: The included studies encompassed diverse patient populations and evaluated various surgical techniques, outcomes, complications, and advancements in head and neck reconstruction. The
review identified a variety of flaps utilized in head and neck tumor reconstruction, including free flaps such as the radial forearm, anterolateral thigh, scapular tip, and myocutaneous flaps, among others. The success rates for free flap reconstructions ranged from 85% to 100%, with notable variations attributed to patient selection, tumor characteristics, and surgical expertise. Conclusions: Complications such as flap necrosis, infection, hematoma, and donor site morbidity were documented across studies, highlighting the importance of meticulous surgical planning and postoperative care. Furthermore, the
review revealed emerging techniques such as computer-aided design, virtual surgery, stereolithographic models, customized implants, tissue engineering, and allotransplants, offering promising reconstructive armamentarium. Advances in surgical techniques and emerging technologies hold promise for further enhancing reconstructive outcomes, minimizing morbidity, and improving patient quality of life.