Abt Nicholas B, Puram Sidharth V, Sinha Sumi, Sethi Rosh K V, Goyal Neerav, Emerick Kevin S, Lin Derrick T, Deschler Daniel G
Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
Laryngoscope. 2018 Dec;128(12):E409-E415. doi: 10.1002/lary.27393. Epub 2018 Sep 24.
Blood product utilization is monitored to prevent unnecessary transfusions. Head-and-neck pedicled flap reconstruction transfusion-related outcomes were assessed.
One hundred and thirty-six pedicled flap patients were reviewed: 64 supraclavicular artery island flaps (SCAIF), 57 pectoralis major (PM) flaps, and 15 submental (SM) flaps. Outcome parameters included flap-related complications, medical complications, length of stay (LOS), and flap survival. Multivariable logistic regression analyses were performed. Multivariable logistic regression analyses were performed to adjust for relevant pre- and perioperative factors.
Of all head-and-neck pedicled flap patients included in our analyses (n = 136), 40 (29.4%) received blood transfusions. The average pretransfusion hematocrit (Hct) was 24.3% ± 0.5%, with 2.65 ± 0.33 units transfused and a posttransfusion Hct increase of 5.0% ± 0.6%. Transfusion rates differed with PM (47.4%), SCAIF (17.2%), and SM (13.3%) flaps (P < 0.005). Patients undergoing PM reconstruction trended toward higher transfusion requirements (PM 2.89 ± 0.47 units, SC 2.18 ± 0.28 units, and SM 2.00 ± 0.0 units), with transfusion occurring later in the postoperative course (4.9 ± 1.3 days vs. 2.4 ± 0.1 days for all other flaps; P = 0.08). Infection, dehiscence, fistula, or medical complications were not different. Transfusion thresholds of Hct < 21 versus Hct < 27 exhibited no difference in LOS, flap-survival, or medical/flap-related complications.
Transfusion is not associated with surgical or medical morbidity following head and neck pedicled flap reconstruction. There were no differences in outcomes between transfusion triggers of Hct < 21 versus Hct < 27, suggesting that a more conservative transfusion trigger may not precipitate adverse patient complications. Our data recapitulate findings in free flap patients and warrant further investigation of transfusion practices in head and neck flap reconstruction.
监测血液制品的使用情况以防止不必要的输血。评估头颈部带蒂皮瓣重建术后与输血相关的结果。
回顾了136例带蒂皮瓣患者：64例锁骨上动脉岛状皮瓣（SCAIF）、57例胸大肌（PM）皮瓣和15例颏下（SM）皮瓣。结果参数包括皮瓣相关并发症、医疗并发症、住院时间（LOS）和皮瓣存活情况。进行了多变量逻辑回归分析。进行多变量逻辑回归分析以调整相关的术前和围手术期因素。
在我们分析纳入的所有头颈部带蒂皮瓣患者（n = 136）中，40例（29.4%）接受了输血。输血前平均血细胞比容（Hct）为24.3%±0.5%，输注2.65±0.33单位血液，输血后Hct升高5.0%±0.6%。PM皮瓣（47.4%）、SCAIF皮瓣（17.2%）和SM皮瓣（13.3%）的输血率存在差异（P < 0.005）。接受PM重建的患者输血需求有增加趋势（PM皮瓣2.89±0.47单位，SCAIF皮瓣2.18±0.28单位，SM皮瓣2.00±0.0单位），且输血发生在术后病程较晚阶段（4.9±1.3天，而其他所有皮瓣为2.4±0.1天；P = 0.08）。感染、裂开、瘘管或医疗并发症无差异。血细胞比容<21与血细胞比容<27的输血阈值在住院时间、皮瓣存活或医疗/皮瓣相关并发症方面无差异。
头颈部带蒂皮瓣重建术后输血与手术或医疗发病率无关。血细胞比容<21与血细胞比容<27的输血触发因素在结果上无差异，这表明更保守的输血触发因素可能不会引发不良患者并发症。我们的数据重现了游离皮瓣患者的研究结果，有必要对头颈部皮瓣重建中的输血实践进行进一步研究。
4。《喉镜》，1第28卷：E409 - E415，2018年。
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