Cariati Paolo, Cabello Serrano Almudena, Monsalve Iglesias Fernando, Roman Ramos Maria, Fernandez Solis Jose, Martinez Lara Ildefonso
Oral and Maxillofacial Surgery, Hospital Virgen de las Nieves , Granada , Spain.
J Plast Surg Hand Surg. 2019 Oct;53(5):279-287. doi: 10.1080/2000656X.2019.1606005. Epub 2019 May 8.
The main aim of the present report is to describe our learning curve in microsurgery and how we solved the problems that frequently occur during the first phases of this learning curve. We analyzed the medical records of 69 patients that underwent head and neck reconstruction with free flaps in our department. The patients were divided into two groups. Group 1 included the patients reconstructed between January 2011 and June 2017, whilst Group 2 included those reconstructed between July 2017 and August 2018. A test was used to compare the differences between the two groups in terms of flap failure (failure and partial failure) and eventual clinical errors. The value was set at 0.05. Flap failure and clinical errors were most frequently observed in Group 1 ( < 0.05). Greater awareness of the need for proper functioning of the anastomosis during surgery, along with more exhaustive postoperative monitoring might explain the lower number of failures and signs of vascular compromise observed in Group 2. A number of variables may influence flap survival. Postoperative care, head position, kinking, body temperature, blood pressure and the ability to recognize the sign of vascular compromise all play a fundamental role following surgery. However, microsurgery is not just a routine type of surgery, and a properly trained team with several types of professionals must be adequately prepared to obtain acceptable results.
本报告的主要目的是描述我们在显微外科方面的学习曲线，以及我们如何解决在该学习曲线的最初阶段经常出现的问题。我们分析了在我们科室接受游离皮瓣进行头颈部重建的69例患者的病历。患者被分为两组。第一组包括2011年1月至2017年6月期间接受重建的患者，而第二组包括2017年7月至2018年8月期间接受重建的患者。采用一种检验方法来比较两组在皮瓣失败（失败和部分失败）以及最终临床失误方面的差异。设定 值为0.05。皮瓣失败和临床失误在第一组中最为常见（ ＜0.05）。手术期间对吻合口正常功能需求的更高认识，以及更详尽的术后监测，可能解释了第二组中观察到的失败数量和血管受损迹象较少的原因。一些变量可能会影响皮瓣存活。术后护理、头部位置、扭结、体温、血压以及识别血管受损迹象的能力在手术后都起着至关重要的作用。然而，显微外科不仅仅是一种常规手术类型，一个经过适当培训、由多种专业人员组成的团队必须做好充分准备才能取得可接受的结果。
