影响失败游离皮瓣成功挽救的因素。
Factors impacting successful salvage of the failing free flap.
作者信息
Sweeny Larissa, Curry Joseph, Crawley Meghan, Cave Taylor, Stewart Matthew, Luginbuhl Adam, Heffelfinger Ryan, Krein Howard, Petrisor Daniel, Bender-Heine Adam, Wax Mark K
机构信息
Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Science Center - New Orleans, New Orleans, Louisiana, USA.
Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
出版信息
Head Neck. 2020 Dec;42(12):3568-3579. doi: 10.1002/hed.26427. Epub 2020 Aug 26.
BACKGROUND
Understanding factors impacting successful salvage of a compromised free flap.
METHODS
Multi-institutional review of free flap reconstructions for head and neck defects (n = 1764).
RESULTS
Free flap compromise rate: 9% (n = 162); 46% salvaged (n = 74). Higher salvage rates in initial 48 hours (64%) vs after (30%; P < .001). Greater compromise (14%) and failure (8%) if inset challenging vs straightforward (6% compromise, 4% failure; P = .035). Greater compromise (23%) and failure (17%) following intraoperative anastomosis revision vs no revision (7% compromise, 4% failure; P < .0001). Success following arterial insufficiency was lower (60% failed, 40% salvaged) vs venous congestion (23% failed, 77% salvaged) (P < .0001). Greater flap salvage following thrombectomy (66%) vs no thrombectomy (34%; P < .0001). Greater flap salvage if operative duration ≤8 hours (57%), vs >8 hours (40%) (P = .04).
CONCLUSIONS
There were higher rates of free flap salvage if the vascular compromise occurred within 48 hours, if due to venous congestion, if operative duration ≤8 hours, and if the anastomosis did not require intraoperative revision.
背景
了解影响挽救受损游离皮瓣成功的因素。
方法
对多机构的头颈部缺损游离皮瓣重建术进行回顾（n = 1764）。
结果
游离皮瓣受损率：9%（n = 162）；46%得以挽救（n = 74）。最初48小时内的挽救率更高（64%），而之后的挽救率为30%（P < 0.001）。与简单植入相比，植入困难时的受损率更高（14%）且失败率更高（8%）（简单植入时的受损率为6%，失败率为4%；P = 0.035）。术中吻合口修复后的受损率更高（23%）且失败率更高（17%），而未进行修复时的受损率为7%，失败率为4%（P < 0.0001）。动脉供血不足后的成功率较低（60%失败，40%挽救），而静脉淤血后的成功率为（23%失败，77%挽救）（P < 0.0001）。取栓后的皮瓣挽救率更高（66%），而未取栓时的挽救率为34%（P < 0.0001）。手术时长≤8小时时的皮瓣挽救率更高（57%），而手术时长>8小时时的挽救率为40%（P = 0.04）。
结论
如果血管受损发生在48小时内、因静脉淤血导致、手术时长≤8小时且吻合口无需术中修复，则游离皮瓣的挽救率更高。
Zotero 插件