Department of Surgery, Abington-Jefferson Health, Abington, Pennsylvania.
Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
J Reconstr Microsurg. 2022 Jun;38(5):343-360. doi: 10.1055/s-0041-1733922. Epub 2021 Aug 17.
Microsurgical free flaps have largely supplanted pedicled flaps as the gold standard for head and neck cancer reconstruction. However, incidence of postoperative complications after accounting for patient comorbidities based on choice of reconstruction has not been well-defined in the literature in recent years.
Patients undergoing head and neck reconstruction were identified in the 2011-2016 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database and stratified into groups by free flap, myocutaneous pedicled flap, and other reconstruction. Demographics were analyzed and covariates balanced using overlap propensity score-based weighting. Logistic regression was used for binary outcomes and Gamma generalized linear model was used for length of stay.
A total of 4,712 patients met inclusion criteria out of which 1,297 patients (28%) underwent free flap, 208 patients (4%) pedicled flap, and 3,207 patients (68%) had other, or no reconstruction performed. After adjusting for patient and disease-specific factors, pedicled flap reconstruction was associated with a higher risk of deep vein thrombosis (odds ratio [OR] = 2.64, confidence interval [CI] 1.02-6.85, = 0.045), sepsis (OR = 2.95, CI 1.52-5.71, = 0.001), and infection (OR = 2.03, CI 1.39-2.96, <0.001) compared with free flap reconstruction. Free flaps had the longest mean operative time compared with the other two groups (unadjusted 578 vs. 440 vs. 326, <0.001). Pedicled flaps had a lower incidence of bleeding requiring transfusion (adjusted OR = 0.65, CI 0.50-0.85, = 0.002), and lower incidence of prolonged mechanical ventilation (adjusted OR = 0.33, CI 0.12-0.92, = 0.034) compared with free flaps. There was no difference in rates of reoperation, hospital readmission, or hospital length-of-stay between pedicled and free flaps.
Myocutaneous pedicled flaps are associated with higher overall short-term postoperative complications compared with free flaps in head and neck reconstruction, which demonstrate a more favorable morbidity profile without significantly impacting hospital readmission, reoperation, or length-of-stay.
显微游离皮瓣在很大程度上取代了带蒂皮瓣，成为头颈部癌症重建的金标准。然而，近年来，文献中并未明确界定根据重建选择考虑患者合并症后术后并发症的发生率。
在 2011 年至 2016 年 ACS-NSQIP（美国外科医师学会国家外科质量改进计划）数据库中确定接受头颈部重建的患者，并根据游离皮瓣、肌皮蒂瓣和其他重建方式将患者分为组。使用重叠倾向评分加权法分析人口统计学数据并平衡协变量。二元结果采用逻辑回归，住院时间采用伽马广义线性模型。
共有 4712 例患者符合纳入标准，其中 1297 例（28%）接受游离皮瓣，208 例（4%）接受带蒂皮瓣，3207 例（68%）接受其他或无重建。在调整患者和疾病特异性因素后，与游离皮瓣重建相比，带蒂皮瓣重建与深静脉血栓形成（优势比 [OR] = 2.64，置信区间 [CI] 1.02-6.85， = 0.045）、脓毒症（OR = 2.95，CI 1.52-5.71， = 0.001）和感染（OR = 2.03，CI 1.39-2.96， <0.001）的风险更高。与其他两组相比，游离皮瓣的平均手术时间最长（未调整的 578 与 440 与 326， <0.001）。带蒂皮瓣的输血相关出血发生率较低（调整后的 OR = 0.65，CI 0.50-0.85， = 0.002），机械通气时间延长的发生率较低（调整后的 OR = 0.33，CI 0.12-0.92， = 0.034）与游离皮瓣相比。带蒂皮瓣与游离皮瓣相比，再次手术、住院再入院或住院时间无差异。
在头颈部重建中，与游离皮瓣相比，肌皮蒂瓣与更高的总体短期术后并发症相关，这显示出更有利的发病率谱，而不会显著影响住院再入院、再次手术或住院时间。
