Haughey B H, Wilson E, Kluwe L, Piccirillo J, Fredrickson J, Sessions D, Spector G
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Otolaryngol Head Neck Surg. 2001 Jul;125(1):10-7. doi: 10.1067/mhn.2001.116788.
We undertook this study of free flap reconstruction of the head and neck to stratify patients and procedures, to determine how donor site preference changed over time, to assess medical and surgical outcomes, and to identify variables associated with complications.
We analyzed computerized medical records from 236 patients who underwent a total of 241 reconstructions at a tertiary academic medical center in St. Louis between 1989 and 1998. We created a more detailed retrospective database of 141 of those patients by using 48 perioperative variables and 7 adverse outcome measures. Multivariate statistical models were used to analyze associations between variables and outcomes.
The fibula became the preferred donor site for mandibular reconstruction, and the radial forearm became the preferred donor site for pharyngoesophageal reconstruction. For the 241 procedures, the mortality rate was 2.1%, the median length of stay was 11 days, and the flap survival rate was 95%. Administration of more than 7 L of crystalloid during surgery and age over 55 were associated with major medical complications. Blood transfusion, prognostic comorbidity, and number of surgeons correlated with length of stay. Cigarette smoking and receipt of more than 7 L of crystalloid during surgery were associated with overall flap complications, and weight loss of more than 10% before surgery, more than one operating surgeon, and cigarette smoking were associated with major flap complications.
Risk to patients and transferred tissue is low in free flap head and neck reconstruction. Age, smoking history, and weight loss should be considered during patient selection. Fluid balance should be considered during and after surgery. Division of labor for patient care should be carefully delineated among surgeons in a teaching setting.
我们开展了这项关于头颈部游离皮瓣重建的研究，以对患者和手术进行分层，确定供区偏好如何随时间变化，评估医学和手术结果，并识别与并发症相关的变量。
我们分析了1989年至1998年期间在圣路易斯的一家三级学术医疗中心接受总共241次重建手术的236例患者的计算机化病历。我们使用48个围手术期变量和7项不良结局指标，为其中141例患者创建了更详细的回顾性数据库。采用多变量统计模型分析变量与结局之间的关联。
腓骨成为下颌骨重建的首选供区，桡侧前臂成为咽食管重建的首选供区。在这241例手术中，死亡率为2.1%，中位住院时间为11天，皮瓣存活率为95%。手术期间输注超过7升晶体液和年龄超过55岁与主要医学并发症相关。输血、预后合并症和外科医生数量与住院时间相关。吸烟和手术期间输注超过7升晶体液与总体皮瓣并发症相关，术前体重减轻超过10%、有不止一名手术医生以及吸烟与主要皮瓣并发症相关。
头颈部游离皮瓣重建中患者和移植组织的风险较低。在患者选择过程中应考虑年龄、吸烟史和体重减轻情况。手术期间及术后应考虑液体平衡。在教学环境中，外科医生之间应仔细划分患者护理的分工。
