Huang Robert Y, Sercarz Joel A, Smith Jesse, Blackwell Keith E
Department of Surgery, Division of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.
Laryngoscope. 2005 Mar;115(3):517-21. doi: 10.1097/01.mlg.0000157827.92884.c5.
Infection is associated with free flap failure in patients undergoing microvascular flap reconstruction. This study investigates the association between infection arising from salivary fistulas, microvascular thrombosis, and free flap failure.
Prospective laboratory investigation and retrospective clinical investigation.
The effect of saliva-induced infection on the patency of microvascular thrombosis was studied in an experimental animal model and in a clinical series of patients undergoing free flap reconstruction of the head and neck. In the laboratory phase of this study, rat femoral artery anastomoses were inoculated with freshly collected rat saliva to simulate a postoperative salivary fistula. The incidence of femoral artery thrombosis was determined. In the clinical arm of this study, the incidence of salivary fistulas and resulting clinical outcome in 588 head and neck free flap reconstructions were examined.
In the animal experiment, arterial patency was 95% after 10 days for both the control group and the salivary contamination group. In the clinical series, 24 patients developed salivary fistulas during the postoperative period. No cases of microvascular thrombosis were attributed to salivary fistula formation.
Postoperative salivary fistulas do not appear to be strongly associated as a contributory factor toward free flap failure in head and neck reconstruction. On the basis of our current understanding of this condition, we describe a rational approach for management of patients who develop salivary fistulas after microvascular head and neck reconstruction.
在接受微血管皮瓣重建的患者中，感染与游离皮瓣失败相关。本研究调查唾液瘘引起的感染、微血管血栓形成与游离皮瓣失败之间的关联。
前瞻性实验室研究和回顾性临床研究。
在实验动物模型以及一系列接受头颈部游离皮瓣重建的临床患者中，研究唾液诱导的感染对微血管血栓形成通畅性的影响。在本研究的实验室阶段，将新鲜采集的大鼠唾液接种到大鼠股动脉吻合处，以模拟术后唾液瘘。测定股动脉血栓形成的发生率。在本研究的临床部分，检查了588例头颈部游离皮瓣重建中唾液瘘的发生率及由此产生的临床结果。
在动物实验中，对照组和唾液污染组在10天后动脉通畅率均为95%。在临床系列中，24例患者在术后出现唾液瘘。没有微血管血栓形成的病例归因于唾液瘘的形成。
术后唾液瘘似乎并非头颈部重建中游离皮瓣失败的重要促成因素。基于我们目前对这种情况的理解，我们描述了一种对头颈部微血管重建后发生唾液瘘的患者进行合理管理的方法。
