Division of Head and Neck Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA.
Laryngoscope. 2012 Oct;122(10):2160-3. doi: 10.1002/lary.23457. Epub 2012 Jun 6.
OBJECTIVES/HYPOTHESIS: To compare free flap reconstructive cases from 1999 and 2009 with respect to patient characteristics, surgical characteristics, outcomes, and complications; and to discuss the evolution in free flap reconstruction at a single institution during this time period.
Retrospective cohort comparison.
Free flap reconstruction cases from 1999 and 2009 were collected into two cohorts. Retrospective chart review was performed to extract patient characteristics, surgical characteristics, and outcomes. Cohorts were compared with respect to extracted data with statistical significance set at P < .05.
There were 39 free flap reconstructions performed in 1999 and 81 performed in 2009. Patients in the 2009 cohort had higher American Society of Anesthesiologists scores and incidence of cardiovascular disease (P = .009 and .0045, respectively). Median operative time decreased from 12 hours in 1999 to 9 hours in 2009 (P < .0001). Median length of stay decreased from 14 to 9 days (P = .0006). The rate of perioperative return to the operating room to manage complications decreased from 30% to 17% (P = .103). There were five unsalvaged flap failures in 1999 (12.8%) compared to two failures in 2009 (2.5%) (P = .036).
Patients undergoing free flap reconstruction are increasingly older and have more medical comorbidities. Despite these challenges, increased efficiency and teamwork stemming from accumulated institutional experience have led to decreased operative times, length of stay, and complication rates and increased overall success rates.
目的/假设：比较 1999 年和 2009 年的游离皮瓣重建病例，比较患者特征、手术特征、结果和并发症；并讨论在此期间单家机构游离皮瓣重建的演变。
回顾性队列比较。
将 1999 年和 2009 年的游离皮瓣重建病例分为两组。对病历进行回顾性分析，提取患者特征、手术特征和结果。两组间比较采用统计学意义 P<0.05。
1999 年共行 39 例游离皮瓣重建，2009 年共行 81 例。2009 年组患者的美国麻醉医师协会评分和心血管疾病发生率较高（P=0.009 和 0.0045）。手术时间中位数从 1999 年的 12 小时缩短至 2009 年的 9 小时（P<0.0001）。住院时间中位数从 14 天缩短至 9 天（P=0.0006）。围手术期因并发症返回手术室的比例从 30%降至 17%（P=0.103）。1999 年有 5 例皮瓣失败无法挽救（12.8%），而 2009 年有 2 例（2.5%）（P=0.036）。
接受游离皮瓣重建的患者年龄越来越大，合并症也越来越多。尽管面临这些挑战，但由于机构经验的积累，效率和团队合作的提高导致手术时间、住院时间、并发症发生率降低，总体成功率提高。
