Kwok Alvin C, Agarwal Jayant P
School of Medicine, Division of Plastic Surgery, University of Utah, 30 N 1900 E, 3B400, Salt Lake City, UT, 84132.
Microsurgery. 2017 Sep;37(6):531-538. doi: 10.1002/micr.30121. Epub 2016 Oct 7.
We sought to use the NSQIP database to determine the national rate and predictors of free flap failure based upon flap sites and flap types.
Free flaps were identified using the 2005-2010 NSQIP database. We examined overall flap failure rates as well as failure rates based upon flap sites (head and neck, extremities, trunk, and breast) and flap types (muscle, fascial, skin, bone, and bowel flaps). Univariate and multivariate analyses were used to determine predictors of flap failure.
There were 1,187 microvascular free tissue transfers identified. The overall flap failure rate was 5.1%. Head and neck flaps had the highest rate of free flap failure at 7.7%. Prolonged operative time is an independent predictor of flap failure for all free flaps (OR: 2.383, P = 0.0013). When examining predictors of failure by flap site, free flaps to the breast with prolonged operative time are independently associated with flap failure (OR: 2.288, P = 0.0152). When examining predictors of flap failure by flap type, muscle based free flaps with an ASA classification ≥3 are associated with flap failure (P = 0.0441).
Risk factors for free flap failure differ based upon flap site and flap type. Prolonged operative time is an independent risk factor for the failure of free flaps used for breast reconstruction. An ASA classification ≥3 is associated with the failure of free muscle based flaps. Our findings identify actionable areas that may help to improve free flap success.
我们试图利用美国国立外科手术质量改进计划（NSQIP）数据库，根据皮瓣部位和皮瓣类型确定游离皮瓣失败的全国发生率及预测因素。
利用2005 - 2010年NSQIP数据库识别游离皮瓣。我们检查了总体皮瓣失败率以及基于皮瓣部位（头颈部、四肢、躯干和乳房）和皮瓣类型（肌肉、筋膜、皮肤、骨和肠皮瓣）的失败率。采用单因素和多因素分析来确定皮瓣失败的预测因素。
共识别出1187例微血管游离组织移植。总体皮瓣失败率为5.1%。头颈部皮瓣的游离皮瓣失败率最高，为7.7%。手术时间延长是所有游离皮瓣失败的独立预测因素（比值比：2.383，P = 0.0013）。在按皮瓣部位检查失败预测因素时，手术时间延长的乳房游离皮瓣与皮瓣失败独立相关（比值比：2.288，P = 0.0152）。在按皮瓣类型检查皮瓣失败预测因素时，美国麻醉医师协会（ASA）分级≥3的肌肉游离皮瓣与皮瓣失败相关（P = 0.0441）。
游离皮瓣失败的危险因素因皮瓣部位和皮瓣类型而异。手术时间延长是用于乳房重建的游离皮瓣失败的独立危险因素。ASA分级≥3与肌肉游离皮瓣失败相关。我们的研究结果确定了可能有助于提高游离皮瓣成功率的可操作领域。
