Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Georgetown University School of Medicine, Washington, District of Columbia, USA.
Microsurgery. 2022 Oct;42(7):696-702. doi: 10.1002/micr.30935. Epub 2022 Jul 6.
Free tissue transfer (FTT) lower limb salvage requires costly multidisciplinary care. Traditionally, patients who undergo FTT reconstruction for lower extremity (LE) wounds were admitted to the intensive care unit (ICU) in the immediate postoperative period for close monitoring. During the COVID-19 pandemic, our practice shifted toward admitting FTT patients to the floor postoperatively instead of the ICU. The purpose of this study is to compare surgical outcomes in patients admitted to the floor versus ICU immediately following LE free flap reconstruction.
We retrospectively reviewed patients undergoing LE FTT reconstruction from 2011 to 2021. Flap monitoring consisted of an implantable Cook-Swartz Doppler probe for muscle flaps and ViOptix tissue oximetry for fasciocutaneous flaps; clinical exam and hand-held dopplers were not the primary flap monitoring techniques. Patients were divided into two groups depending on whether they went to the ICU or floor postoperatively. To ensure proper comparability between cohorts, we corrected for age, BMI and Charlson Comorbidity Index (CCI) using 1:2 propensity score matching (floor: ICU). Primary outcomes included early postoperative complications, flap takeback and salvage, flap success, and postoperative length of stay (LOS).
A total of 252 patients were identified. Forty-five patients (17.9%) were admitted to the floor postoperatively and 207 patients (82.1%) to the ICU. Overall, microsurgical success rate was 97.2%, which was similar for floor and ICU patients. Flap takeback and salvage were similar between cohorts. Average postoperative LOS was significantly shorter in floor patients (15.7 vs. 19.1 days, p = 0.043).
Our findings suggest that postoperative floor admission does not decrease flap success rates and should be considered in patients who undergo FTT to LE reconstruction and are otherwise stable. In the ongoing era of health care cost containment, microsurgery centers should consider appropriate floor training to allow medically stable free flap patients to avoid an ICU stay.
游离组织移植（FTT）下肢保肢需要昂贵的多学科护理。传统上，接受下肢（LE）创面 FTT 重建的患者在术后立即入住重症监护病房（ICU）进行密切监测。在 COVID-19 大流行期间，我们的治疗方案转变为术后将 FTT 患者收治到普通病房，而不是 ICU。本研究的目的是比较 LE 游离皮瓣重建后立即入住普通病房与 ICU 的患者的手术结果。
我们回顾性分析了 2011 年至 2021 年接受 LE FTT 重建的患者。皮瓣监测包括用于肌肉皮瓣的植入式 Cook-Swartz 多普勒探头和用于筋膜皮瓣的 ViOptix 组织血氧仪；临床检查和手持式多普勒仪不是主要的皮瓣监测技术。根据患者术后是否入住 ICU 或普通病房，将其分为两组。为了确保两组之间的适当可比性，我们使用 1:2 倾向评分匹配（普通病房：ICU）校正年龄、BMI 和 Charlson 合并症指数（CCI）。主要结局包括术后早期并发症、皮瓣回收和挽救、皮瓣成功和术后住院时间（LOS）。
共确定了 252 名患者。45 名患者（17.9%）术后入住普通病房，207 名患者（82.1%）入住 ICU。总体而言，显微外科成功率为 97.2%，普通病房和 ICU 患者的成功率相似。两组皮瓣回收和挽救情况相似。普通病房患者的平均术后 LOS 明显缩短（15.7 天 vs. 19.1 天，p=0.043）。
我们的研究结果表明，术后入住普通病房不会降低皮瓣成功率，对于接受 FTT 重建 LE 且病情稳定的患者，应考虑入住普通病房。在当前医疗保健成本控制的时代，显微外科中心应考虑进行适当的普通病房培训，以使病情稳定的游离皮瓣患者避免入住 ICU。
