Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2019 Oct;161(4):598-604. doi: 10.1177/0194599819860809. Epub 2019 Aug 6.
To investigate causes of failure of free flap reconstructions in patients undergoing reconstruction of head and neck defects.
Case series with chart review.
Single tertiary care center.
Patients underwent reconstruction between January 2007 and June 2017 (n = 892). Variables included were clinical characteristics, social history, defect site, donor tissue, ischemia time, and postoperative complications. Statistical methods used include univariable and multivariable analysis of failure.
The overall failure rate was 4.8% (n = 43). Intraoperative ischemia time was associated with free flap failures (odds ratio [OR], 1.062; 95% confidence interval [CI], 1.019-1.107; = .004) for each addition of 5 minutes. Free flaps that required pedicle revision at time of initial surgery were 9 times more likely to fail (OR, 9.953; 95% CI, 3.242-27.732; < .001). Patients who experienced alcohol withdrawal after free flap placement were 3.7 times more likely to experience flap failure (OR, 3.690; 95% CI, 1.141-10.330; = .031). Ischemia time remained an independent significant risk factor for failure in nonosteocutaneous free flaps (OR, 1.105; 95% CI, 1.031-1.185). Alcohol withdrawal was associated with free flap failure in osteocutaneous reconstructions (OR, 5.046; 95% CI 1.103-19.805) while hypertension was found to be protective (OR, 0.056; 95% CI, 0.000-0.445).
Prolonged ischemia time, pedicle revision, and alcohol withdrawal were associated with higher rates of flap failure. Employing strategies to minimize ischemic time may have potential to decrease failure rates. Flaps that require pedicle revision and patients with a history of significant alcohol use require closer monitoring.
研究头颈部缺损重建患者游离皮瓣重建失败的原因。
病例系列，病历回顾。
单一体位护理中心。
2007 年 1 月至 2017 年 6 月期间，患者接受了重建（n=892）。纳入的变量包括临床特征、社会史、缺损部位、供区组织、缺血时间和术后并发症。使用的统计方法包括单变量和多变量分析失败原因。
总的失败率为 4.8%（n=43）。术中缺血时间与游离皮瓣失败相关（比值比[OR]，1.062；95%置信区间[CI]，1.019-1.107；P=.004），每增加 5 分钟缺血时间，失败的风险就增加 1.062 倍。在初次手术时需要修改蒂的游离皮瓣发生失败的可能性是 9 倍（OR，9.953；95%CI，3.242-27.732；P<.001）。游离皮瓣放置后出现酒精戒断的患者发生皮瓣失败的可能性是 3.7 倍（OR，3.690；95%CI，1.141-10.330；P=.031）。缺血时间仍然是非骨皮瓣游离皮瓣失败的独立显著危险因素（OR，1.105；95%CI，1.031-1.185）。酒精戒断与骨皮瓣重建中的游离皮瓣失败相关（OR，5.046；95%CI，1.103-19.805），而高血压则有保护作用（OR，0.056；95%CI，0.000-0.445）。
长时间的缺血时间、蒂的修改和酒精戒断与更高的皮瓣失败率相关。采用策略尽量减少缺血时间可能有助于降低失败率。需要修改蒂的皮瓣和有大量饮酒史的患者需要更密切的监测。
