Implantable Venous Doppler Monitoring in Head and Neck Free Flap Reconstruction Increases the Salvage Rate
Implantable Venous Doppler Monitoring in Head and Neck Free Flap Reconstruction Increases the Salvage Rate
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DOI：
10.1097/prs.0b013e3181d0ab23
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发表时间：
2010-04-01
影响因子：
3.6
通讯作者：
Leon, Pablo
中科院分区：
文献类型：
--
作者：
Paydar, Keyianoosh Z.;Hansen, Scott L.;Leon, Pablo
背景：游离皮瓣的成功取决于对失败皮瓣的快速识别和后续补救。传统的游离皮瓣监测技术需要外部组件，而植入式监测器很容易指示游离皮瓣灌注的变化，特别是在头颈部重建中使用的埋藏皮瓣。方法：本文回顾性分析了2000年4月至2006年12月期间155例患者的169个连续头颈部游离皮瓣，主要用于肿瘤手术缺损的重建，结果：169个皮瓣中，埋藏皮瓣25个，占14.8%。血栓形成（n = 16）、血肿（n = 2）或闭合过紧（n = 1）引起的皮瓣缺血发生在11.2%的病例中。多普勒探头检测到所有失败的游离皮瓣，我们能够挽救19个缺血皮瓣中的18个（94.7%）。所有多普勒检测到缺血的非埋藏皮瓣（100%）和四个埋藏的自由皮瓣中的三个都被挽救（75%）。共有33例并发症（19.5%），其中9.5%的皮瓣发生血栓形成，而12个皮瓣需要再次手术进行血管翻修（7.1%）。死亡率低于1%（0.6%）。使用植入式多普勒探头的总体成功率为98.2%，这是最近报道的情况下，所有的游离皮瓣在文献中，与埋和非埋头和颈部游离flaps.Conclusion抢救率显着提高：植入式多普勒探头是一个有用的监测设备，埋游离皮瓣，应考虑使用在头和颈部重建。（Plast。重建125：1129，2010）。
Background: Free flap success depends on rapid identification and subsequent salvage of failing flaps. Conventional free flap monitoring techniques require an external component, whereas an implantable monitor readily indicates changes in free flap perfusion, especially in buried flaps used in head and neck reconstruction.Methods: This is a retrospective review of 169 consecutive head and neck free flaps reconstructed mostly for oncologic surgical defects in 155 patients from April of 2000 to December of 2006, all of which were monitored by an implantable venous Doppler device.Results: There were 25 buried flaps, representing 14.8 percent of 169 flaps. Flap ischemia caused by thrombosis (n = 16), hematoma (n = 2), or tight closure (n = 1) occurred in 11.2 percent of the cases. The Doppler probe detected all of the failing free flaps, and we were able to salvage 18 of 19 ischemic flaps (94.7 percent). All Doppler-detected ischemic nonburied flaps (100 percent) and three of the four buried free flaps were salvaged (75 percent). There were 33 total complications (19.5 percent), with thrombosis occurring in 9.5 percent of the flaps, whereas 12 flaps required reoperation for vascular revision (7.1 percent). The mortality rate was less than 1 percent (0.6 percent). The overall success rate using the implantable Doppler probe was 98.2 percent, which was similar to that of the most recent reported cases of all free flaps in the literature, with significant improvement in the salvage rate for both buried and nonburied head and neck free flaps.Conclusion: The implantable Doppler probe is a useful monitoring device in buried free flaps and should be considered for use in head and neck reconstruction. (Plast. Reconstr. Surg. 125: 1129, 2010.)