Hospital Privado Universitario de Córdoba. Córdoba, Argentina..
Hospital Privado Universitario de Córdoba. Córdoba, Argentina.
Rev Fac Cien Med Univ Nac Cordoba. 2021 Dec 28;78(4):335-339. doi: 10.31053/1853.0605.v78.n4.29523.
Microvascular free-flap reconstruction is one of the treatment options after large resection of head and neck neoplasms. The objectives of this study are to identify short-term outcomes and risk factors for flap complication in patients who underwent neoplasms resection of head and neck with microvascular free-flap reconstruction.
Retrospective study of patients who underwent surgery for head and neck neoplasm with microvascular free-flap reconstruction between January 2014-2020. Complications were studied at 30-days follow-up and divided into medical and flap complications. Factors independently associated with flap complication were analyzed.
We included 31 patients (15 men). The mean age was 60 years. Reconstruction was performed with radial-forearm flap in 74% (n=23) and with free-fibula flap in 26% (n=8). Mean surgical time was 420 minutes. Median hospital length of stay was 7 days. Medical complications were of 23%. Minor complications were of 35% and major of 32%. There was no mortality in 30-days follow-up. Flap complications were of 35%. Reintervention was of 29%, surgical site infection of 9%, dehiscence of 29% and flap loss of 9.7%. Surgical site infection was independently associated with prolonged surgical time (Odds ratio [OR]=1.03, IC95%=0.98-1.04, p=0.02) and body mass index equal to or greater than 30 (OR=1.38, IC95%=0.84-2.26, p=0.04) while flap loss was associated with prolonged surgical time (OR=1.02, IC95%=0.99-1.04, p=0.01).
Microsurgical free-flap reconstruction should be considered in our population in patients with large head and neck neoplasms. Preoperative assessment of the risk of postoperative complications is essential before selecting patients for this surgery.
微血管游离皮瓣重建是头颈部肿瘤大切除后的治疗选择之一。本研究的目的是确定头颈部肿瘤切除后接受微血管游离皮瓣重建患者的短期结果和皮瓣并发症的危险因素。
回顾性研究 2014 年 1 月至 2020 年期间接受头颈部肿瘤微血管游离皮瓣重建手术的患者。在 30 天随访时研究并发症，并将其分为医疗和皮瓣并发症。分析与皮瓣并发症独立相关的因素。
我们纳入了 31 名患者（15 名男性）。平均年龄为 60 岁。重建采用桡侧前臂皮瓣 74%（n=23），游离腓骨皮瓣 26%（n=8）。平均手术时间为 420 分钟。中位住院时间为 7 天。医疗并发症为 23%。轻微并发症为 35%，主要并发症为 32%。30 天随访无死亡。皮瓣并发症为 35%。再次干预为 29%，手术部位感染为 9%，裂开为 29%，皮瓣丢失为 9.7%。手术部位感染与手术时间延长独立相关（优势比[OR]=1.03，95%置信区间[IC95%]=0.98-1.04，p=0.02）和体重指数等于或大于 30（OR=1.38，95%置信区间[IC95%]=0.84-2.26，p=0.04），而皮瓣丢失与手术时间延长相关（OR=1.02，95%置信区间[IC95%]=0.99-1.04，p=0.01）。
在我们的人群中，对于大型头颈部肿瘤患者，应考虑使用显微外科游离皮瓣重建。在为患者选择这种手术之前，对术后并发症风险进行术前评估至关重要。
