Las David E, de Jong Tim, Zuidam J Michiel, Verweij Norbert M, Hovius Steven E R, Mureau Marc A M
Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Plast Reconstr Aesthet Surg. 2016 Jul;69(7):894-906. doi: 10.1016/j.bjps.2016.02.001. Epub 2016 Feb 12.
Reconstructive microsurgery is a powerful method of treating various complex defects. However, flap loss remains a possibility, leading to additional surgery, hospitalisation and costs. Consequently, it is important to know which factors lead to an increased risk of flap failure, so that measures can be undertaken to reduce this risk. Therefore, we analysed our results over a 20-year period to identify risk factors for flap failure after breast, head and neck and extremity reconstruction. The medical files of all patients treated between 1992 and 2012 were reviewed. Patient characteristics, surgical data and post-operative complications were scored, and independent risk factors for flap loss were identified. Reconstruction with a total of 1530 free flaps was performed in 1247 patients. Partial and total flap loss occurred in 5.5% and 4.4% of all free flaps, respectively. In all flaps, signs of compromised flap circulation were a risk factor for flap failure. More specifically, the risk factors for flap failure in breast reconstruction were previous radiotherapy, venous anastomosis revision, gluteal artery perforator (GAP) flap choice and post-operative bleeding. In head and neck reconstruction, pulmonary co-morbidity and anastomosis to the lingual vein or superficial temporal artery were risk factors, whereas a radial forearm flap reduced the risk. In extremity reconstruction, diabetes, prolonged anaesthesia time and post-operative wound infection were risk factors. Independent pre-, intra- and post-operative risk factors for flap failure after microvascular breast, head and neck and extremity reconstruction were identified. These results may be used to improve patient counselling and to adjust treatment algorithms to further reduce the chance of flap failure.
重建显微外科手术是治疗各种复杂缺损的有效方法。然而，皮瓣丢失仍有可能发生，这会导致额外的手术、住院治疗及费用。因此，了解哪些因素会导致皮瓣失败风险增加非常重要，以便能够采取措施降低这种风险。为此，我们分析了20年间的结果，以确定乳房、头颈部和四肢重建术后皮瓣失败的风险因素。回顾了1992年至2012年间所有接受治疗患者的病历。对患者特征、手术数据和术后并发症进行评分，并确定皮瓣丢失的独立风险因素。1247例患者共进行了1530例游离皮瓣重建。部分和完全皮瓣丢失分别发生在所有游离皮瓣的5.5%和4.4%。在所有皮瓣中，皮瓣血液循环受损的迹象是皮瓣失败的一个风险因素。更具体地说，乳房重建中皮瓣失败的风险因素是既往放疗、静脉吻合口修复、臀动脉穿支（GAP）皮瓣选择和术后出血。在头颈部重建中，肺部合并症以及与舌静脉或颞浅动脉的吻合是风险因素，而桡侧前臂皮瓣可降低风险。在四肢重建中，糖尿病、麻醉时间延长和术后伤口感染是风险因素。确定了微血管乳房、头颈部和四肢重建术后皮瓣失败的独立术前、术中和术后风险因素。这些结果可用于改善患者咨询，并调整治疗方案以进一步降低皮瓣失败的几率。
