Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA.
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA.
Laryngoscope. 2021 Mar;131(3):518-524. doi: 10.1002/lary.28886. Epub 2020 Jul 27.
OBJECTIVES/HYPOTHESIS: To review the management of failed free tissue transfers among four large institutions over a 13-year period to provide data and analysis for a logical, algorithmic, experience-based approach to the management of failed free flaps.
Retrospective case series.
A multi-institutional retrospective chart review of free tissue transfers to the head and neck region between 2006 and 2019 was performed. Patients with a failed free flap during their hospitalization after surgery to the head and neck were identified and reviewed. Patient age, co-morbidities, risk factors, flap characteristics, tumor specifics, and length of hospital stay were reviewed, collected, and analyzed.
One hundred eighteen flap failures met criteria. The most common failed flap in this review was the osteocutaneous flap 52/118 (44%). The recipient site of the initial free flap (P < .001) was the only statistically significant parameter strongly correlated with management. Osteocutaneous flap failures, fasciocutaneous, bowel, and muscle-only flaps tended to be managed most commonly with a second free flap. Myocutaneous flap failures were managed equally with either a second free flap or a regional flap.
The most important factor in management of a failed free flap is the recipient site. A second free flap is often the preferred treatment, but in the acute setting, local or regional flaps may be viable options depending on the recipient site, circumstances of flap loss, and patient- specific comorbidities. An algorithm for management of the acute flap loss is presented in this review.
4 Laryngoscope, 131:518-524, 2021.
目的/假设：回顾四家大型机构在 13 年内对游离组织移植失败的处理情况，为游离皮瓣失败的管理提供逻辑、基于算法的经验分析方法。
回顾性病例系列研究。
对 2006 年至 2019 年间头颈部游离组织移植的多机构回顾性图表进行了审查。确定了手术后住院期间游离皮瓣失败的患者，并进行了回顾性分析。对患者年龄、合并症、危险因素、皮瓣特征、肿瘤具体情况和住院时间进行了回顾、收集和分析。
118 例皮瓣失败符合标准。本研究中最常见的失败皮瓣是骨皮瓣 52/118（44%）。游离皮瓣的初始受区（P < .001）是与管理相关性最强的唯一统计学显著参数。骨皮瓣失败、筋膜皮瓣、肠瓣和单纯肌瓣通常最常采用第二次游离皮瓣进行治疗。肌皮瓣失败同样可以采用第二次游离皮瓣或区域性皮瓣进行治疗。
游离皮瓣失败管理中最重要的因素是受区。第二次游离皮瓣通常是首选治疗方法，但在急性情况下，根据受区、皮瓣丧失情况和患者特定的合并症，局部或区域性皮瓣可能是可行的选择。本文回顾中提出了急性皮瓣丧失的处理算法。
4 级喉镜，131：518-524，2021 年。
