Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers
Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers
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DOI：
10.1097/01.prs.0000264077.07779.50
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发表时间：
2007-07-01
影响因子：
3.6
通讯作者：
Wei, Fu-Chan
中科院分区：
文献类型：
--
作者：
Chen, Kuang-Te;Mardini, Samir;Wei, Fu-Chan
背景：显微外科游离组织移植已成为一种可靠的技术。然而，由于循环系统受损，5% 至 25% 的转移皮瓣需要重新探查。本研究旨在评估游离组织移植后皮瓣受损发生的时间及其与抢救结果的相关性。方法：2002年1月至2003年6月期间，进行了1142例游离皮瓣手术，其中113例皮瓣（9.9％）因受损而接受了重新探查。所有患者均在显微外科重症监护室接受为期 5 天的护理。通过回顾性审查，确定了出现损害的时间，并将其与抢救结果相关联。结果：72 个皮瓣 (63.7%) 完全抢救，23 个皮瓣 (20.4%) 部分抢救。十八个襟翼（15.9%）完全失效。 93 个皮瓣 (82.3%) 在 24 小时内出现循环障碍； 108 例（95.6%）在 72 小时内出现循环障碍，92 例皮瓣（85.2%）在此期间得到挽救。术后 1 周出现受损的 3 个皮瓣中的 1 个被抢救。与那些没有立即异常体征的皮瓣相比，进入显微外科重症监护病房时出现皮瓣受损的完全抢救率显着较低（40.9% vs 69.2%，p = 0.01）。 结论：皮瓣受损的出现时间是皮瓣抢救结果的重要预测因素。由训练有素的护士和外科医生在特殊的显微外科重症监护病房进行强化皮瓣监测，可以及早发现血管受损情况，从而获得更好的结果。
Background: Microsurgical free tissue transfer has become a reliable technique. Nevertheless, 5 to 25 percent of transferred flaps require re-exploration due to circulatory compromise. This study was conducted to evaluate the timing of occurrence of flap compromise following free tissue transfer, and its correlation with salvage outcome.Methods: Between January of 2002 and June of 2003, 1142 free flap procedures were per-formed and 113 flaps (9.9 percent) received re-exploration due to compromise. All patients were cared for in the microsurgical intensive care unit for 5 days. Through a retrospective review, timing of presentation of compromise was identified and correlated with salvage outcome.Results: Seventy-two flaps (63.7 percent) were completely salvaged and 23 (20.4 percent) were partially salvaged. Eighteen flaps (15.9 percent) failed completely. Ninety-three flaps (82.3 percent) presented with circulatory compromise within 24 hours; 108 (95.6 percent) presented with circulatory compromise within 72 hours, and 92 flaps (85.2 percent) were salvaged within this period. One out of the three flaps presenting with compromise 1 week postoperatively was salvaged. Flaps presenting with compromise upon admission to the microsurgical intensive care unit had significantly lower complete salvage rates as compared with those without immediate abnormal signs (40.9 percent versus 69.2 percent, p = 0.01).Conclusions: The time of presentation of flap compromise is a significant predictor of flap salvage outcome. Intensive flap monitoring at a special microsurgical intensive care unit by well-trained nurses and surgeons allows for early detection of vascular compromise, which leads to better outcomes.