Zhai Qin-Kai, Dai Wei, Tan Xue-Xin, Sun Jian, Zhang Chen-Ping, Qin Xing-Jun
Attending Surgeon, Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Associate Professor, Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, China.
J Oral Maxillofac Surg. 2018 Mar;76(3):664-669. doi: 10.1016/j.joms.2017.07.170. Epub 2017 Aug 3.
The purpose of this study was to analyze the reliability of the deep venous drainage system of the free radial forearm flap.
The authors implemented a retrospective cohort study and enrolled patients admitted for the evaluation and management of head and neck tumors with radial forearm flap reconstruction. The primary predictor variables were the donor site veins, including the deep, dual, and superficial venous drainage systems. The primary outcome measurement was the incidence of venous compromise. Potential confounders included patient demographics, history of chemotherapy with or without radiotherapy, defect sites, and the recipient artery and vein. The χ test and logistic regression analysis were used for statistical analysis.
The final study population consisted of 520 patients (mean age, 54 years) who underwent head and neck soft tissue reconstruction using the free radial forearm flap. Patients with the deep system (odds ratio [OR] = 0.251; 95% confidence interval [CI], 0.108-0.581) or dual system (OR = 0.197; 95% CI, 0.064-0.605) had a markedly lower risk of venous compromise than those with the superficial system. The overall incidence of inadequate outflow was 2.5% (5 of 204) when the deep system was used alone and 8.9% (19 of 212) when the superficial system was used alone (P = .004).
Patients with the deep venous drainage system had a statistically lower risk of venous compromise. This study recommends using the deep system as a drainage vein for the free radial forearm flap.
本研究旨在分析游离桡侧前臂皮瓣深静脉引流系统的可靠性。
作者开展了一项回顾性队列研究，纳入因头颈部肿瘤行桡侧前臂皮瓣重建术而入院评估及治疗的患者。主要预测变量为供区静脉，包括深静脉、双静脉及浅静脉引流系统。主要观察指标为静脉受压的发生率。潜在混杂因素包括患者人口统计学资料、有无放化疗史、缺损部位以及受区动静脉。采用χ检验和逻辑回归分析进行统计学分析。
最终研究人群包括520例（平均年龄54岁）行游离桡侧前臂皮瓣头颈部软组织重建术的患者。深静脉系统（优势比[OR]=0.251；95%置信区间[CI]，0.108 - 0.581）或双静脉系统（OR = 0.197；95% CI，0.064 - 0.605）的患者发生静脉受压的风险明显低于浅静脉系统的患者。单独使用深静脉系统时，总体流出不足发生率为2.5%（204例中的5例），单独使用浅静脉系统时为8.9%（212例中的19例）（P = 0.004）。
深静脉引流系统的患者发生静脉受压的风险在统计学上较低。本研究建议将深静脉系统用作游离桡侧前臂皮瓣的引流静脉。
