Vascular Complications and Free Flap Salvage in Head and Neck Reconstructive Surgery Analysis of 150 Cases of Reexploration
Vascular Complications and Free Flap Salvage in Head and Neck Reconstructive Surgery Analysis of 150 Cases of Reexploration
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DOI：
10.1097/sap.0000000000001011
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发表时间：
2017-03-01
影响因子：
1.5
通讯作者：
Perng, Cherng-Kang
中科院分区：
文献类型：
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作者：
Chiu, Yen-Hao;Chang, Dun-Hao;Perng, Cherng-Kang
简介：尽管游离组织移植的可靠性很好，但皮瓣失败是毁灭性的，除了患者的发病率外，它还可能增加住院时间和相关费用。先前的研究已经评估了与皮瓣挽救相关的因素，以及皮瓣挽救手术的手术策略。本研究的目的是分享我们的经验，再勘探和描述的操作标准处理血管thrombosis.Methods：我们回顾性分析了150（1258）自由皮瓣的头部和颈部重建，显示血管妥协的迹象，在我们的机构在2002年至2015年的13年期间。分析患者的人口统计学资料，包括性别、年龄、病前健康状况、个人病史、再探查指征、皮瓣类型和受体血管数量。还记录了初次手术结束和挽救手术之间的天数。抢救后并发症的发生率（血肿形成，伤口裂开，感染需要手术干预）和整体皮瓣survival.Results：的150皮瓣，87皮瓣有明显的动脉或静脉血栓形成，其中34个失败，需要第二次游离皮瓣或带蒂皮瓣重建。其余53人已成功获救。虽然血管血栓形成被认为是皮瓣损失的一个主要因素，没有显着差异，发现任何因素之间的患者与可挽救皮瓣和那些无法挽救flaps.Conclusions：血管血栓形成是皮瓣损失的一个主要因素。静脉血栓形成的发生率较高，但动脉血栓形成可能更严重。手术技术和围手术期管理的改进是高度可靠的。我们相信，严格的皮瓣监测模式;训练有素，敬业的工作人员;和立即再探索将有可能进一步提高皮瓣存活率和优化生活质量。
Introduction: Despite the excellent reliability of free tissue transfer, flap failure is devastating, and in addition to patient morbidity, it may increase hospital stay and associated costs. Previous studies have evaluated factors related to flap salvage, regarding the operative strategy for flap salvage surgery. The present study aimed to share our experience of reexploration and describe operative standards dealing with vascular thrombosis.Methods: We retrospectively reviewed 150 (of 1258) free flaps for head and neck reconstruction that showed signs of vascular compromise at our institution during a 13-year period between 2002 and 2015. Patient demographics, including sex, age, premorbid health status, personal history, indication for reexploration, flap type, and number of recipient vessels, were analyzed. Days between the end of initial surgery and salvage surgery were also recorded. The incidence of postsalvage complications (hematoma formation, wound dehiscence, and infection requiring surgical intervention) and the overall flap survival were recorded.Results: Of the 150 flaps, 87 flaps had evident arterial or venous thrombosis; 34 of these failed and required a second free flap or pedicle flap reconstruction. The remaining 53 were successfully salvaged. Although vascular thrombosis was found to be a major contributing factor in flap loss, no significant differences in any factor were found between patients with salvageable flaps and those with unsalvageable flaps.Conclusions: Vascular thrombosis is a major contributing factor in flap loss. The incidence of venous thrombosis is higher, but arterial thrombosis may be more severe. Improvements in the surgical technique and perioperative management are highly reliable. We believe that strict models of flap monitoring; well-trained, dedicated staff; and immediate reexploration will potentially further improve flap survival and optimize the quality of life.