Suh Jeffrey D, Sercarz Joel A, Abemayor Elliot, Calcaterra Thomas C, Rawnsley Jeffery D, Alam Daniel, Blackwell Keith E
Division of Head and Neck Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
Arch Otolaryngol Head Neck Surg. 2004 Aug;130(8):962-6. doi: 10.1001/archotol.130.8.962.
To determine the incidence and causes of perioperative complications in patients who undergo microvascular free flap procedures for reconstruction of the head and neck.
Academic tertiary care medical center.
A total of 400 consecutive microvascular free flap procedures were performed for reconstruction of the head and neck, with 95% of the defects arising after the treatment of malignancies. Flap donor sites included radial forearm (n = 183), fibula (n = 145), rectus abdominis (n = 38), subscapular system (n = 28), iliac crest (n = 5), and a jejunal flap. Patient-related characteristics (age; sex; diagnosis; comorbidity level; tumor stage; defect site; primary vs secondary reconstruction; and history of surgery, radiation therapy, or chemotherapy) and the incidence of perioperative complications were recorded prospectively over a 7-year period.
The perioperative mortality was 1.3%. Overall, perioperative complications occurred in 36.1% of all cases. Free flaps proved to be extremely reliable, with a 0.8% incidence of free flap failure and a 3% incidence of partial flap necrosis. Perioperative medical complications occurred in 20.5% of cases, with pulmonary, cardiac, and infectious complications predominating. Multivariate statistical analysis showed significant relationships between the incidence of perioperative complications and preoperative comorbidity level as indicated by American Society of Anesthesiologists (ASA) status (P =.02).
The present study confirms that free flaps are extremely reliable in achieving successful reconstruction of the head and neck. The incidence of perioperative complications is related to preoperative comorbidity level.
确定接受微血管游离皮瓣手术进行头颈部重建患者围手术期并发症的发生率及原因。
学术性三级医疗中心。
共对400例患者连续进行微血管游离皮瓣手术以重建头颈部，其中95%的缺损是在恶性肿瘤治疗后出现的。皮瓣供区包括桡侧前臂（n = 183）、腓骨（n = 145）、腹直肌（n = 38）、肩胛下系统（n = 28）、髂嵴（n = 5）以及空肠皮瓣。前瞻性记录了7年期间患者的相关特征（年龄、性别、诊断、合并症程度、肿瘤分期、缺损部位、一期与二期重建以及手术、放疗或化疗史）和围手术期并发症的发生率。
围手术期死亡率为1.3%。总体而言，36.1%的病例发生了围手术期并发症。游离皮瓣被证明极其可靠，游离皮瓣失败率为0.8%，部分皮瓣坏死率为3%。20.5%的病例发生了围手术期医疗并发症，以肺部、心脏和感染性并发症为主。多变量统计分析显示，围手术期并发症的发生率与美国麻醉医师协会（ASA）分级所表明的术前合并症程度之间存在显著相关性（P = 0.02）。
本研究证实游离皮瓣在成功重建头颈部方面极其可靠。围手术期并发症的发生率与术前合并症程度有关。
