显微游离组织移植术后管理的效果。
Efficacy of the postoperative management after microsurgical free tissue transfer.
机构信息
Department of Maxillofacial Surgery, Stomatology and Facial Plastic Surgery, Hospices Civils de Lyon - Claude-Bernard-Lyon 1 University, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
Department of Otorhinolaryngology, Head and Neck Surgery, Hospices Civils de Lyon - Claude-Bernard-Lyon 1 University, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
出版信息
J Stomatol Oral Maxillofac Surg. 2017 Jun;118(3):173-177. doi: 10.1016/j.jormas.2017.03.007. Epub 2017 Apr 5.
INTRODUCTION
The physical and medical postoperative measures after free flap reconstruction vary substantially between surgical units. The objective of this review was to identify the postoperative measures which proved a significant positive effect on free flap survival.
METHOD
A review was conducted in the MEDLINE database on the English and French literature.
RESULTS AND DISCUSSION
Twenty-eight articles were retained. A meta-analysis of 4984 patients who were given antithrombotics (viz. antiplatelets and anticoagulants) postoperatively found that these treatments were of no significant benefit to free flap survival and increased the risk of postoperative hematoma. Postoperative transfusions did not favor free flap survival and were associated with a higher incidence of medical complications. Preoperative anemia was a risk factor for free flap failure. Blood pressure control, vasodilators, antioxidants, corticotherapy, oxygen therapy, and prolonged immobilization were of no proven benefit.
CONCLUSION
No postoperative therapy, whether drug-based or not, has been shown to have a significant positive effect on free flap survival.
简介
游离皮瓣重建术后的物理和医学措施在不同的外科单位之间有很大的不同。本综述的目的是确定对游离皮瓣存活有显著积极影响的术后措施。
方法
在 MEDLINE 数据库中对英语和法语文献进行了回顾。
结果与讨论
共保留了 28 篇文章。对接受术后抗血栓治疗（即抗血小板和抗凝治疗）的 4984 名患者进行的荟萃分析发现，这些治疗对游离皮瓣存活没有显著益处，反而增加了术后血肿的风险。术后输血不利于游离皮瓣存活，并与更高的医疗并发症发生率相关。术前贫血是游离皮瓣失败的一个危险因素。血压控制、血管扩张剂、抗氧化剂、皮质激素治疗、氧疗和长时间固定都没有被证明有好处。
结论
没有一种术后治疗方法，无论是药物治疗还是非药物治疗，都被证明对游离皮瓣存活有显著的积极影响。
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