Chaivanichsiri P
Center for Microsurgery of Extremities, Nopparatrajathanee Hospital, Bunkoom, Bangkok, Thailand.
Plast Reconstr Surg. 1999 Sep;104(4):970-5. doi: 10.1097/00006534-199909040-00011.
A retrospective analysis of the records of 107 free flap transplants in 94 patients operated on between May of 1992 and September of 1997 at the Center for Microsurgery of Extremities, Nopparatrajathanee Hospital, was conducted to study the risk factors leading to free flap failure. These factors were periods of operation to reflect the experience of the surgeon, locations of the defects, anastomotic techniques, and the use of vein grafts. Chi-square, Fisher's exact test, and multiple logistic regression analysis were used to determine the significance of the data. The overall vascular complication rate was 28 percent (30 of 107 transplants) and the re-exploration rate was 13 percent (14 of 107 transplants), the flap salvage rate was 50 percent (7 of 14 flaps), whereas the overall failure rate was 15 percent (16 of 107 transplants). The significant factors that caused free flap failure were the experience of the surgeon and the use of vein grafts. The most important experience was in the choice and preparation of the recipient vessel. When the surgeon gained more experience in the past 2 years (from October of 1995 to September of 1997), the success rate improved significantly. Moreover, the use of vein grafts no longer affected the outcome. Therefore, in this investigation the most important factor that improved the outcome of free tissue transplantation in the extremities was the experience of the surgeon in choosing and preparing the recipient vessels.
对1992年5月至1997年9月期间在暖武里府诺帕拉查尼医院肢体显微外科中心接受手术的94例患者的107例游离皮瓣移植记录进行回顾性分析，以研究导致游离皮瓣失败的危险因素。这些因素包括反映外科医生经验的手术时长、缺损部位、吻合技术以及静脉移植的使用情况。采用卡方检验、费舍尔精确检验和多元逻辑回归分析来确定数据的显著性。总体血管并发症发生率为28%（107例移植中有30例），再次探查率为13%（107例移植中有14例），皮瓣挽救率为50%（14例皮瓣中有7例），而总体失败率为15%（107例移植中有16例）。导致游离皮瓣失败的显著因素是外科医生的经验和静脉移植的使用。最重要的经验在于受区血管的选择和准备。当外科医生在过去两年（1995年10月至1997年9月）积累了更多经验时，成功率显著提高。此外，静脉移植的使用不再影响结果。因此，在本研究中，改善肢体游离组织移植结果的最重要因素是外科医生在选择和准备受区血管方面的经验。
