Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA.
Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri, USA.
Otolaryngol Head Neck Surg. 2022 Aug;167(2):224-235. doi: 10.1177/01945998211044683. Epub 2021 Sep 7.
To systematically review management of flap loss in head and neck construction with free tissue transfer as compared with locoregional flap or conservative management.
Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched up to October 2019.
Candidate articles were independently reviewed by 2 authors. Articles were considered eligible if they included adequate reporting of flap management after flap loss and outcomes for survival of reconstruction, length of hospitalization, and perioperative complications.
A total of 429 patients had acute flap failure in the perioperative period. The overall success with a secondary free flap was 93% (95% CI, 0.89-0.97; n = 26 studies, = 12.8%). There was no difference in hospitalization length after secondary reconstruction between free tissue transfer and locoregional flaps or conservative management (relative risk of hospitalization ≥2 weeks, 96%; 95% CI, 0.80-1.14; n = 3 studies, = 0). The pooled relative risk of perioperative complications following free tissue transfer was 0.60 when compared with locoregional flap or conservative management (95% CI, 0.40-0.92; n = 5 studies, = 0).
Salvage reconstruction with free tissue transfer has a high success rate. Second free flaps following flap failure had a similar length of hospitalization and lower overall complication rate than locoregional reconstruction or conservative management. A second free tissue transfer, when feasible, is likely a more reliable and effective procedure for salvage reconstruction.
系统回顾与局部皮瓣或保守治疗相比，游离组织移植在头颈部重建中处理皮瓣丢失的方法。
截至 2019 年 10 月，检索了 Medline、Embase、Scopus、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库和 ClinicalTrials.gov。
由 2 名作者独立对候选文章进行了评价。如果文章充分报告了皮瓣丢失后的皮瓣处理情况以及重建存活率、住院时间和围手术期并发症等结局，则认为其符合纳入标准。
共有 429 例患者在围手术期发生急性皮瓣失败。二期游离皮瓣的总体成功率为 93%（95%CI，0.89-0.97；n=26 项研究， =12.8%）。与局部皮瓣或保守治疗相比，二期游离组织移植后住院时间无差异（再次住院≥2 周的相对风险，96%；95%CI，0.80-1.14；n=3 项研究， =0）。与局部皮瓣或保守治疗相比，游离组织移植术后围手术期并发症的汇总相对风险为 0.60（95%CI，0.40-0.92；n=5 项研究， =0）。
游离组织移植挽救性重建的成功率较高。与局部皮瓣或保守治疗相比，皮瓣失败后二期游离皮瓣的住院时间相似，总并发症发生率较低。当可行时，二期游离组织移植可能是一种更可靠、有效的挽救性重建方法。
