Department of Craniomaxillofacial and Oral Surgery, University Hospital Zurich, Frauenklinikstr. 24, CH-8091 Zurich, Switzerland.
Microsurgery. 2010;30(3):242-8. doi: 10.1002/micr.20758.
Microvascular free tissue transfer is a reliable technique for head and neck reconstruction with success rates of 90-99%. Currently, there is no consensus concerning antithrombotic agents, antibiotics, or monitoring techniques. Therefore, the aim of this study was to review current literature dealing with microvascular free-tissue transfer and factors influencing the outcome. In addition to excellent microsurgical techniques, coupling devices are a promising new technique, but are not useful in all arteries. Antibiotics should be given in three doses, as a more lengthy dosage time seems to have no advantage. The risk for elderly patients can be best assessed by the American Society of Anesthesiologists (ASA) score, but early mobilization, including intense chest physiotherapy, is important. Anticoagulation can be considered in cases of small vessels, significant size mismatch, vein graft, or vessels of poor quality. Monitoring should be done hourly during the first 24 hours and then every 4 hours for the next 2 postoperative days.
游离微血管组织移植是头颈部重建的可靠技术，成功率为 90-99%。目前，对于抗血栓药物、抗生素或监测技术尚未达成共识。因此，本研究旨在回顾游离微血管组织移植的现有文献，并探讨影响手术效果的因素。除了精湛的显微外科技术外，耦合装置是一种很有前途的新技术，但并非所有动脉都适用。抗生素应分三次给予，因为较长的用药时间似乎没有优势。美国麻醉医师协会（ASA）评分可用于评估老年患者的风险，但早期活动，包括剧烈的胸部物理治疗，非常重要。对于小血管、显著的尺寸不匹配、静脉移植物或质量较差的血管，可以考虑抗凝治疗。应在术后 24 小时内每小时监测一次，然后在接下来的 2 天每 4 小时监测一次。
