Bui Duc T, Cordeiro Peter G, Hu Qun-Ying, Disa Joseph J, Pusic Andrea, Mehrara Babak J
New York, N.Y. From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.
Plast Reconstr Surg. 2007 Jun;119(7):2092-2100. doi: 10.1097/01.prs.0000260598.24376.e1.
Microvascular free tissue transfer is a reliable method for reconstruction of complex surgical defects. However, there is still a small risk of flap compromise necessitating urgent reexploration. A comprehensive study examining the causes and methods of avoiding or treating these complications has not been performed. The purpose of this study was to review the authors' experience with a large number of microvascular complications over an 11-year period.
This was a retrospective review of all free flaps performed from 1991 to 2002 at Memorial Sloan-Kettering Cancer Center. All patients who required emergent reexploration were identified, and the incidence of vascular complications and methods used for their management were analyzed.
A total of 1193 free flaps were performed during the study period, of which 6 percent required emergent reexploration. The most common causes for reexploration were pedicle thrombosis (53 percent) and hematoma/bleeding (30 percent). The overall flap survival rate was 98.8 percent. Venous thrombosis was more common than arterial thrombosis (74 versus 26 percent) and had a higher salvage rate (71 versus 40 percent). Salvaged free flaps were reexplored more quickly than failed flaps (4 versus 9 hours after detection; p = 0.01). There was no significant difference in salvage rate in flaps requiring secondary vein grafting or thrombolysis as compared with those with anastomotic revision only.
Microvascular free tissue transfer is a reliable reconstructive technique with low failure rates. Careful monitoring and urgent reexploration are critical for salvage of compromised flaps. The majority of venous thromboses can be salvaged. Arterial thromboses can be more problematic. An algorithm for flap exploration and salvage is presented.
游离组织微血管移植是修复复杂手术缺损的可靠方法。然而，皮瓣出现问题仍有小风险，需要紧急再次手术探查。尚未开展一项全面研究来探讨这些并发症的成因及避免或处理方法。本研究旨在回顾作者在11年期间处理大量微血管并发症的经验。
对1991年至2002年在纪念斯隆-凯特琳癌症中心进行的所有游离皮瓣移植进行回顾性研究。确定所有需要紧急再次手术探查的患者，分析血管并发症的发生率及其处理方法。
研究期间共进行了1193例游离皮瓣移植，其中6%需要紧急再次手术探查。再次手术探查的最常见原因是蒂部血栓形成（53%）和血肿/出血（30%）。皮瓣总体存活率为98.8%。静脉血栓形成比动脉血栓形成更常见（74%对26%），且挽救率更高（71%对40%）。挽救成功的游离皮瓣比失败的皮瓣再次手术探查的时间更早（发现后4小时对9小时；p = 0.01）。与仅进行吻合口修复的皮瓣相比，需要二次静脉移植或溶栓的皮瓣在挽救率上无显著差异。
游离组织微血管移植是一种可靠的重建技术，失败率低。仔细监测和紧急再次手术探查对挽救出现问题的皮瓣至关重要。大多数静脉血栓形成可以挽救。动脉血栓形成可能更棘手。本文提出了皮瓣探查和挽救的流程。
