Chang Catherine S, Chu Michael W, Nelson Jonas A, Basta Marten, Gerety Patrick, Kanchwala Suhail K, Wu Liza C
Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
J Reconstr Microsurg. 2017 Jun;33(5):318-327. doi: 10.1055/s-0037-1598618. Epub 2017 Feb 25.
Microvascular anastomotic patency is fundamental to head and neck free flap reconstructive success. The aims of this study were to identify factors associated with intraoperative arterial anastomotic issues and analyze the impact on subsequent complications and cost in head and neck reconstruction. A retrospective review was performed on all head and neck free flap reconstructions from 2005 to 2013. Patients with intraoperative, arterial anastomotic difficulties were compared with patients without. Postoperative outcomes and costs were analyzed to determine factors associated with microvascular arterial complications. A regression analysis was performed to control for confounders. Total 438 head and neck free flaps were performed, with 24 (5.5%) having intraoperative arterial complications. Patient groups and flap survival between the two groups were similar. Free flaps with arterial issues had higher rates of unplanned reoperations (< 0.001), emergent take-backs ( = 0.034), and major surgical ( = 0.002) and respiratory ( = 0.036) complications. The overall cost of reconstruction was nearly double in patients with arterial issues ( = 0.001). Regression analysis revealed that African American race (OR = 5.5, < 0.009), use of vasopressors (OR = 6.0, = 0.024), end-to-side venous anastomosis (OR = 4.0, = 0.009), and use of internal fixation hardware (OR =3.5, = 0.013) were significantly associated with arterial complications. Intraoperative arterial complications may impact complications and overall cost of free flap head and neck reconstruction. Although some factors are nonmodifiable or unavoidable, microsurgeons should nonetheless be aware of the risk association. We recommend optimizing preoperative comorbidities and avoiding use of vasopressors in head and neck free flap cases to the extent possible.
微血管吻合通畅是头颈部游离皮瓣重建成功的基础。本研究的目的是确定与术中动脉吻合问题相关的因素，并分析其对头颈部重建术后并发症和成本的影响。 对2005年至2013年所有头颈部游离皮瓣重建手术进行了回顾性研究。将术中出现动脉吻合困难的患者与未出现困难的患者进行比较。分析术后结果和成本，以确定与微血管动脉并发症相关的因素。进行回归分析以控制混杂因素。 共进行了438例头颈部游离皮瓣手术，其中24例（5.5%）出现术中动脉并发症。两组患者的分组和皮瓣存活率相似。出现动脉问题的游离皮瓣计划外再次手术率（<0.001）、紧急回纳率（=0.034）、重大手术并发症率（=0.002）和呼吸并发症率（=0.036）更高。出现动脉问题的患者重建的总成本几乎翻倍（=0.001）。回归分析显示，非裔美国人种族（OR=5.5，<0.009）、使用血管加压药（OR=6.0，=0.024）、端侧静脉吻合（OR=4.0，=0.009）和使用内固定器械（OR=3.5，=0.013）与动脉并发症显著相关。 术中动脉并发症可能会影响游离皮瓣头颈部重建的并发症和总成本。尽管有些因素不可改变或不可避免，但显微外科医生仍应意识到风险关联。我们建议尽可能优化术前合并症，并在头颈部游离皮瓣病例中避免使用血管加压药。
