Kagaya Yu, Arikawa Masaki, Miyamoto Shimpei
Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2017 Aug 24;5(8):e1446. doi: 10.1097/GOX.0000000000001446. eCollection 2017 Aug.
Late arterial thrombosis of a free flap is rare and usually unsalvageable because it is hard to detect. We herein report 2 cases of arterial thrombosis of a free flap after microvascular head and neck reconstruction due to the combined factors of pedicle artery loop and compression by a swollen submandibular gland, the occurrence of thrombosis in both of which was > 72 hours after the operation. In case 1, the arterial thrombosis was undetectable, and it was too late for a successful take-back operation, so the flap was lost. However, we applied the lessons learned from case 1 and were able to detect the late arterial thrombosis of case 2 at an early stage; we subsequently salvaged the flap successfully. During the take-back operation in both cases, it was found that the submandibular gland became swollen and compressed the pedicle artery, which then became occluded due to a steep loop formation. Postoperative swelling of the submandibular gland can sometimes compress the vascular pedicle, and complete occlusion of the pedicle artery may occur when it is looped. Meticulous care concerning the geometry of the vascular pedicle is required to avoid such complications.
游离皮瓣晚期动脉血栓形成较为罕见，且通常难以挽救，因为很难检测到。我们在此报告2例微血管头颈部重建术后游离皮瓣动脉血栓形成的病例，其原因是蒂动脉袢和肿大的下颌下腺压迫这两个因素共同作用，两例血栓形成均发生在术后72小时以上。在病例1中，动脉血栓无法检测到，进行成功的挽救手术为时已晚，因此皮瓣坏死。然而，我们吸取了病例1的教训，能够在早期检测到病例2的晚期动脉血栓形成；随后我们成功挽救了皮瓣。在两例的挽救手术中，均发现下颌下腺肿大并压迫蒂动脉，蒂动脉因形成陡峭的袢而闭塞。下颌下腺术后肿胀有时会压迫血管蒂，当血管蒂形成袢时，蒂动脉可能会完全闭塞。需要精心关注血管蒂的形态，以避免此类并发症。
