Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.
Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Umberto I University Hospital, Rome, Italy.
Head Neck. 2019 Sep;41(9):2914-2920. doi: 10.1002/hed.25767. Epub 2019 Apr 9.
Interposition vein grafts (IVG) and vascular bridge flaps (VBF) have been exploited as vascular conduit in challenging head and neck reconstructions.
A retrospective review was conducted on 6025 flaps. The effect of patients' characteristics and length of IVG on flap compromise and loss were analyzed. Comparison between IVG and VBF was performed.
The flap compromise and loss rates for the overall group were 8.2% and 3.2%, respectively. An IVG was used in 309 free flaps. The average length of the vein grafts was 6.9 ± 4.2 cm. An unplanned return to the operation room occurred in 32 cases (10.4%) and failure of the flap in 12 patients (3.9%). Binary logistic regression found a significant association between flap compromise and loss rates and length of IVG, hypertension, prior radiation, and neck dissection. In the multiple regression model, length of IVG and prior radiation significantly influenced the outcomes. Thirty-nine patients underwent reconstruction with a long IVG (>10 cm). Twenty-six patients underwent surgical reconstruction with radial forearm flap as a VBF. The rate of flap compromise was higher in the group with a long IVG (P = .01).
In head and neck free flap reconstruction, the length of IVGs and history of radiotherapy are associated with flap compromise and loss. In case of long distance between the pedicle and the recipient site, the use of a VBF bridge should be considered as a safe alternative.
静脉移植血管（IVG）和血管桥皮瓣（VBF）已被用作头颈部重建中具有挑战性的血管移植物。
对 6025 个皮瓣进行回顾性分析。分析了患者特征和 IVG 长度对皮瓣失用和丧失的影响。比较了 IVG 和 VBF。
整体组的皮瓣失用和丧失率分别为 8.2%和 3.2%。309 个游离皮瓣使用了 IVG。静脉移植物的平均长度为 6.9±4.2cm。32 例（10.4%）计划返回手术室，12 例（3.9%）皮瓣失败。二元逻辑回归发现皮瓣失用和丧失率与 IVG 长度、高血压、既往放疗和颈部清扫之间存在显著关联。在多元回归模型中，IVG 长度和既往放疗显著影响结果。39 例患者采用长 IVG（>10cm）进行重建。26 例患者采用桡侧前臂皮瓣作为 VBF 进行手术重建。长 IVG 组皮瓣失用率较高（P=0.01）。
在头颈部游离皮瓣重建中，IVG 长度和放疗史与皮瓣失用和丧失有关。在蒂与受区之间距离较长的情况下，应考虑使用 VBF 桥作为安全的替代方法。
