Outcomes following head neck free flap reconstruction requiring interposition vein graft or vascular bridge flap
Outcomes following head neck free flap reconstruction requiring interposition vein graft or vascular bridge flap
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DOI：
10.1002/hed.25767
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发表时间：
2019-09-01
影响因子：
2.9
通讯作者：
Chen, Hung-Chi
中科院分区：
文献类型：
--
作者：
Di Taranto, Giuseppe;Chen, Shih-Heng;Chen, Hung-Chi
背景间置静脉移植物（IVG）和血管桥皮瓣（VBF）作为血管导管在头颈部重建术中被广泛应用。方法对6025例皮瓣进行回顾性分析。分析患者特征及IVG长度对皮瓣缺损的影响。IVG与VBF比较。结果全组皮瓣妥协率为8.2%，皮瓣丢失率为3.2%。在309个游离皮瓣中使用IVG。移植静脉平均长度为6.9 +/- 4.2 cm。32例（10.4%）发生意外返回手术室，12例（3.9%）皮瓣失败。二元logistic回归发现皮瓣缺损与IVG长度、高血压、既往放疗和颈部剥离之间存在显著相关性。在多元回归模型中，IVG的长度和既往放疗对预后有显著影响。39例患者行长IVG （bbb10 cm）重建。26例患者行前臂桡侧皮瓣重建手术。IVG较长组皮瓣受损率较高（P = 0.01）。结论头颈部游离皮瓣重建术中，ivg的长度和放疗史与皮瓣的受损和丢失有关。如果椎弓根与受体之间距离较远，则应考虑使用VBF桥作为安全的选择。
Background Interposition vein grafts (IVG) and vascular bridge flaps (VBF) have been exploited as vascular conduit in challenging head and neck reconstructions. Methods A retrospective review was conducted on 6025 flaps. The effect of patients' characteristics and length of IVG on flap compromise and loss were analyzed. Comparison between IVG and VBF was performed. Results The flap compromise and loss rates for the overall group were 8.2% and 3.2%, respectively. An IVG was used in 309 free flaps. The average length of the vein grafts was 6.9 +/- 4.2 cm. An unplanned return to the operation room occurred in 32 cases (10.4%) and failure of the flap in 12 patients (3.9%). Binary logistic regression found a significant association between flap compromise and loss rates and length of IVG, hypertension, prior radiation, and neck dissection. In the multiple regression model, length of IVG and prior radiation significantly influenced the outcomes. Thirty-nine patients underwent reconstruction with a long IVG (>10 cm). Twenty-six patients underwent surgical reconstruction with radial forearm flap as a VBF. The rate of flap compromise was higher in the group with a long IVG (P = .01). Conclusions In head and neck free flap reconstruction, the length of IVGs and history of radiotherapy are associated with flap compromise and loss. In case of long distance between the pedicle and the recipient site, the use of a VBF bridge should be considered as a safe alternative.