Comparative assessment of wound healing by using a local flap and full-thickness skin graft in reconstructive head and neck surgery

Objective: to present a comparative analysis of wound healing process and to evaluate the clinical effectiveness of using a local flap and a full-thickness skin graft in reconstructive surgery of head and neck skin tumors.

Materials and methods. There were analyzed the results of 524 patients’ treatments in the Yaroslavl Regional Clinical Oncological Hospital over the period from 2000 to 2013. For 478 patients skin tumors excisions were performed by the reconstruction with a local flap, and for 46 patients – with a full-thickness skin graft. While making an assessment of wound healing it was considered the dynamics of clinical symptomatology, clinical laboratory measurements, the results of local thermometry, of bacteriological and morphological studies, as well as the results of wound-tensiometry studies. As a comparison of averages, they used Student’s t-test, Mann–Whitney test, χ2 test and Fisher’s exact test with statistically significant results at p < 0,05.

Results. Comprehensive assessment of wound healing after skin tumors excisions of the head and neck with the elimination of the formed defect by using a local flap or a full-thickness skin graft showed that there was a vibrant local inflammatory reaction in both groups of patients up to 5–7 days after the operation. It was determined not only clinically, but also by objective criteria which characterized the wound healing process. Moreover, the hallmark of plastic reconstruction by skin graft was moderate intensity of local inflammation with the background of perceivable trophic abnormalities. Ultimately, the defined characteristics of wound healing process were as-sociated with a high incidence of complicated wound healing, up to 52.2 % using the skin graft and 33.1 % – the local flap. There were prevailed graft trophism problems in the complications structure in the form of partial or complete necrosis, which were particularly characterized for wound closing by free graft. From oncology position indicated wound risks were accompanied sufficiently high 5-year survival rate (81.8 and 93.9 %, respectively). Generally, choosing reconstructive surgery tactics to close the skin defect of the head and neck and considering a smaller percentage of complications it is preferred to use a local flap, in comparison with a free skin graft.

1. Сергеев Ю.Н., Медведев Ю.А., Усатов Д.А. Особенности лечения базалиом лица и шеи. Онкохирургия 2013;(1):147. [Sergeev Yu.N., Medvedev Yu.A., Usatov D.A. Characteristics of basal-cell carcinoma face and neck treatment. Onkokhirurgiya = Oncosurgery 2013;(1):147. (In Russ.)].

2. ЛаричевА.Б., ЧистяковА.Л., КлочихинА.Л. Заживление послеоперационной раны при использовании локального лоскута в хирургии новообразований кожи головы и шеи. Вестник Санкт-Петербургского университета. Серия 11. Медицина 2015;(1):46–55. [Larichev A.B., Chistyakov A.L., Klochikhin A.L. Healing of the postoperative wound using a local flap in surgery of tumors of the skin of the head and neck. Vestnik Sankt-Peterburgskogo universiteta. Seriya 11. Meditsina = Saint Petersburg University Bulletin. Series 11. Medicine 2015;(1):46–55. (In Russ.)].

3. Denever A., Khater A., Farouk O. et al. Can we put a simplified algorithm for reconstruction of large scalp defects following tumor resection? World J Surg Oncol 2011;9:129. DOI: 10.1186/1477-7819-9-129. PMID: 21999171.

4. Ouyang Y.H. Skin cancer of the head and neck. Semin Plast Surg 2010;24(2):117–26. DOI: 10.1055/s-0030-1255329. PMID: 22550432.

5. Salgarelli A.C., Cangiano A., Sartorelli F. et al. The bilobed flap in skin cancer of the face: our experience on 285 cases. J Craniomaxillofac Surg 2009;38(6):460–4. DOI: 10.1016/j.jcms.2009.10.022. PMID: 19939690.

6. Sand M., Sand D., Thrandorf C. et al. Cutaneous lesions of the nose. Head Face Med 2010;6:7. DOI: 10.1186/1746-160X-6-7. PMID: 20525327.

7. Sherry K.R., Reid L.A., Wilmshurst A.D. A five year review of basal cell carcinoma excisions. J Plast Reconstr Aesthet Surg 2010;63(9):1485–9. DOI: 10.1016/j.bjps.2009.09.007. PMID: 19837017.

8. Ларичев А.Б., Клочихин А.Л., Виноградов В.В. Особенности заживления послеоперационных ран шеи и результативность комбинированного лечения больных раком гортани и гортаноглотки. Вестник Санкт-Петербургского университета. Серия 11. Медицина 2008;(1):50–5. [Larichev A.B., Klochikhin A.L., Vinogradov V.V. Especially the healing of postoperative wounds of the neck and the effectiveness of combined treatment for cancer of the larynx and hypopharynx. Vestnik Sankt-Peterburgskogo universiteta. Seriya 11. Meditsina = Saint Petersburg University Bulletin. Series 11. Medicine 2008;(1):50–5. (In Russ.)].

9. Biller J.A., Kim D.W. A contemporary assessment of facial aesthetic preferences. Arch Facial Plast Surg 2009;11(2):91–7. DOI: 10.1001/archfacial.2008.543. PMID: 19289680.

10. Lin S.J., Hanasono M.M., Skoracki R.J. Scalp and calvarial reconstruction. Semin Plast Surg 2008;22(4):281–93. DOI: 10.1055/s-0028-1095887. PMID: 20567704.

11. Ларичев А.Б., Клочихин А.Л., Мовергоз С.В., Чистяков А.Л. Эффективность амбипора в комплексной профилактике раневых инфекционных осложнений после операций на верхних дыхательных путях. Российский медицинский журнал 2005;(6):19–23. [Larichev A.B., Klochikhin A.L., Movergoz S.V., Chistyakov A.L. The effectiveness of ambipor in comprehensive of prevention of trauma of infectious complications after operations on the upper airways. Rossiyskiy meditsinskiy zhurnal = Russian Medical Journal 2005;(6):19–23. (In Russ.)].

12. Ларичев А.Б., Муравьев А.В., Комлев В.Л. и др. Клинико-реологический статус хирургической инфекции мягких тканей. Вестник экспериментальной и клинической хирургии 2016;9(1):43–52. [Larichev A.B., Murav’ev A.V., Komlev V.L. et al. The clinico-rheological status of the soft tissue surgical infection. Vestnik eksperimental’noy i klinicheskoy khirurgii = Bulletin of Experimental and Clinical Surgery 2016;9(1):43–52. (In Russ.)].

13. Мухамадиева К.М., Ганиев Г.Н., Бободжданов Д. Некоторые факторы, влияющие на заживление ран. Анналы пластической, реконструктивной и эстетической хирургии 2006;(4):115–6. [Mukhamadieva K.M., Ganiev G.N., Bobodzhdanov D. Some factors influencing wound healing. Annaly plasticheskoy, rekonstruktivnoy i esteticheskoy khirurgii = Annals of Plastic, Reconstructive and Aesthetic Surgery 2006;(4):115–6. (In Russ.)].

14. Давыдов Ю.А., Ларичев А.Б. Вакуум-терапия ран и раневой процесс. М.: Медицина, 1999. 160 с. [Davydov Yu.A., Larichev A.B. Vacuum therapy of wounds and wound process. Moscow: Meditsina, 1999. 160 p. (In Russ.)].

15. Федорина Т.А., Брайловская Т.В. Клинико-морфологическая и гистометрическая характеристика ран мягких тканей челюстно-лицевой области пациентов в разные сроки после травмы. Стоматология 2009;(3):56–61. [Fedorina T.A., Braylovskaya T.V. Clinic morphological and gist metrical characteristic of soft tissue wounds in the maxilla facial region of patients at different time after injury. Stomatologiya = Stomatology 2009;(3):56–61. (In Russ.)].

16. Haubner F., Ohmann E., Pohl F. et al. Wound healing after radiation therapy: review of the literature. Radiat Oncol 2012;7:162. DOI: 10.1186/1748-717X-7-162. PMID: 23006548.