Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
Department of Otolaryngology - Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, United States of America.
Am J Otolaryngol. 2020 Jul-Aug;41(4):102536. doi: 10.1016/j.amjoto.2020.102536. Epub 2020 May 12.
Identify factors associated with skin graft take in fibula free flaps (FFF) and radial forearm free flaps (RFFF) donor sites.
To determine which factors are associated with decreased skin graft take at the donor site in FFF and RFFF in head and neck patients.
Retrospective Chart Review Case Series.
Multicenter Tertiary Care.
A multicenter retrospective review was performed at three institutions identifying patients who underwent free tissue transfer, specifically either FFF or RFFF, between 2007 and 2017. Patient demographics, medical history, and social history were examined including age, gender, BMI, smoking status, diabetes and preoperative anticoagulation use. Preoperative, intraoperative data, and postoperative data were also examined including tourniquet use, type of flap, area of skin graft, if the skin graft had a donor site or if it was taken from the flap, wound NPWT use, cast use, use of physical therapy, DVT prophylaxis, limb ischemia, heparin drip, and postoperative aspirin use. Statistical analysis was used to determine which factors were significantly associated with skin graft take.
1415 patients underwent a forearm or fibula flap and 938 patients underwent split-thickness skin graft. Of these, 592 patients had sufficient information and were included in the final analysis. There were 371 males and 220 females. The average age was 55.7. Complete skin graft take was seen in 480 patients (81.1%). On univariate analysis, patients with diabetes (p = .003), type of flap (fibula p < .001), skin graft area (p = .006), tourniquet use (p = .003), DVT prophylaxis (p = .008) and casting (p = .003) were significantly associated with decreased skin graft take rate. In a multivariate analysis, diabetes (OR 2.17 (95%CI 1.16-3.98)), fibula flaps (OR 2.86 (95%CI 1.79-4.76)), an increase in skin graft area (OR 1.01 (95%CI 1.01-1.01)), post-operative aspirin (OR 2.63 (95%CI 1.15-5.88), and casting (OR 2.94 (95%CI 1.22-7.14)) were associated with poor rates of skin graft take.
Several factors affect skin graft take rate and should be considered when performing a skin graft for a donor site defect.
确定与腓骨游离皮瓣（FFF）和游离桡侧前臂皮瓣（RFFF）供区皮片移植成活率相关的因素。
确定哪些因素与头颈部患者 FFF 和 RFFF 供区皮片移植成活率降低有关。
回顾性图表研究病例系列。
多中心三级保健。
在三个机构进行了多中心回顾性研究，确定了 2007 年至 2017 年间接受游离组织移植的患者，具体为 FFF 或 RFFF。患者的人口统计学、病史和社会史均进行了检查，包括年龄、性别、BMI、吸烟状况、糖尿病和术前抗凝治疗的使用情况。还检查了术前、术中及术后数据，包括止血带的使用、皮瓣类型、皮片面积、皮片是否取自供区或取自皮瓣、创面负压引流（NPWT）的使用、石膏固定的使用、物理治疗的使用、深静脉血栓形成（DVT）预防、肢体缺血、肝素滴注和术后阿司匹林的使用。采用统计学分析确定与皮片移植成活率显著相关的因素。
1415 例患者行前臂或腓骨皮瓣，938 例患者行中厚层皮片移植。其中 592 例患者信息充足，纳入最终分析。其中男 371 例，女 220 例，平均年龄 55.7 岁。480 例（81.1%）患者皮片完全成活。单因素分析显示，糖尿病患者（p=0.003）、皮瓣类型（腓骨皮瓣 p<0.001）、皮片面积（p=0.006）、止血带使用（p=0.003）、DVT 预防（p=0.008）和石膏固定（p=0.003）与皮片成活率显著相关。多因素分析显示，糖尿病（OR 2.17（95%CI 1.16-3.98））、腓骨皮瓣（OR 2.86（95%CI 1.79-4.76））、皮片面积增加（OR 1.01（95%CI 1.01-1.01））、术后阿司匹林（OR 2.63（95%CI 1.15-5.88））和石膏固定（OR 2.94（95%CI 1.22-7.14））与皮片成活率差有关。
有几个因素影响皮片成活率，在进行供区皮片移植时应予以考虑。
