Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana.
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Laryngoscope. 2020 Feb;130(2):347-353. doi: 10.1002/lary.28177. Epub 2019 Jul 9.
Analyze the cause and significance of a shift in the timing of free flap failures in head and neck reconstruction.
Retrospective multi-institutional review of prospectively collected databases at tertiary care centers.
Included consecutive patients undergoing free flap reconstructions of head and neck defects between 2007 and 2017. Selected variables: demographics, defect location, donor site, free flap failure cause, social and radiation therapy history.
Overall free flap failure rate was 4.6% (n = 133). Distribution of donor tissue by flap failure: radial forearm (32%, n = 43), osteocutaneous radial forearm (6%, n = 8), anterior lateral thigh (23%, n = 31), fibula (23%, n = 30), rectus abdominis (4%, n = 5), latissimus (11%, n = 14), scapula (1.5%, n = 2). Forty percent of flap failures occurred in the initial 72 hours following reconstruction (n = 53). The mean postoperative day for flap failure attributed to venous congestion was 4.7 days (95% confidence interval [CI], 2.6-6.7) versus 6.8 days (CI 5.3-8.3) for arterial insufficiency and 16.6 days (CI 11.7-21.5) for infection (P < .001). The majority of flap failures were attributed to compromise of the arterial or venous system (84%, n = 112). Factors found to affect the timing of free flap failure included surgical indication (P = .032), defect location (P = .006), cause of the flap failure (P < .001), and use of an osteocutaneous flap (P = .002).
This study is the largest to date on late free flap failures with findings suggesting a paradigm shift in the timing of flap failures. Surgical indication, defect site, cause of flap failure, and use of osteocutaneous free flap were found to impact timing of free flap failures.
4 Laryngoscope, 130:347-353, 2020.
分析头颈部重建中游离皮瓣失败时间变化的原因和意义。
对三级护理中心前瞻性收集数据库的连续患者进行回顾性多机构研究。
纳入 2007 年至 2017 年间行游离皮瓣修复头颈部缺损的连续患者。选择的变量包括：人口统计学、缺陷位置、供区部位、游离皮瓣失败原因、社会和放射治疗史。
游离皮瓣总失败率为 4.6%（n = 133）。按皮瓣失败分布供区组织：桡侧前臂（32%，n = 43）、骨皮瓣桡侧前臂（6%，n = 8）、前外侧大腿（23%，n = 31）、腓骨（23%，n = 30）、腹直肌（4%，n = 5）、阔筋膜张肌（11%，n = 14）、肩胛骨（1.5%，n = 2）。40%的皮瓣失败发生在重建后 72 小时内（n = 53）。静脉充血所致皮瓣失败的平均术后天数为 4.7 天（95%置信区间 [CI]，2.6-6.7），动脉功能不全为 6.8 天（CI 5.3-8.3），感染为 16.6 天（CI 11.7-21.5）（P < 0.001）。大多数皮瓣失败归因于动脉或静脉系统的损伤（84%，n = 112）。影响游离皮瓣失败时间的因素包括手术指征（P = 0.032）、缺陷位置（P = 0.006）、皮瓣失败原因（P < 0.001）和使用骨皮瓣（P = 0.002）。
这是迄今为止关于晚期游离皮瓣失败的最大研究，结果表明皮瓣失败时间发生了范式转变。手术指征、缺损部位、皮瓣失败原因和骨皮瓣游离的使用被认为会影响游离皮瓣失败的时间。
4 级喉镜，130：347-353，2020 年。
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