Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.
JAMA Otolaryngol Head Neck Surg. 2022 Oct 1;148(10):965-972. doi: 10.1001/jamaoto.2022.2440.
Studies comparing perioperative outcomes of fibula free flaps (FFFs), osteocutaneous radial forearm free flaps (OCRFFFs), and scapula free flaps (SFFs) have been limited by insufficient sample size.
To compare the perioperative outcomes of patients who underwent FFFs, OCRFFFs, and SFFs.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study assessed the outcomes of 1022 patients who underwent FFFs, OCRFFFs, or SFFs for head and neck reconstruction performed at 1 of 6 academic medical centers between January 2005 and December 2019. Data were analyzed from September 17, 2021, to June 9, 2022.
Patients were stratified based on the flap performed. Evaluated perioperative outcomes included complications (overall acute wound complications, acute surgical site infection [SSI], fistula, hematoma, and flap failure), 30-day readmissions, operative time, and prolonged hospital length of stay (75th percentile, >13 days). Patients were excluded if data on flap type or clinical demographic characteristics were missing. Associations between flap type and perioperative outcomes were analyzed using logistic regression, after controlling for other clinically relevant variables. Adjusted odds ratios (aORs) with 95% CIs were generated.
Perioperative outcomes of 1022 patients (mean [SD] age, 60.7 [14.5] years; 676 [66.1%] men) who underwent major osseous head and neck reconstruction were analyzed; 510 FFFs (49.9%), 376 OCRFFFs (36.8%), and 136 SFFs (13.3%) were performed. Median (IQR) operative time differed among flap types (OCRFFF, 527 [467-591] minutes; FFF, 592 [507-714] minutes; SFF, 691 [610-816] minutes). When controlling for SSI, FFFs (aOR, 2.47; 95% CI, 1.36-4.51) and SFFs (aOR, 2.95; 95% CI, 1.37-6.34) were associated with a higher risk of flap loss than OCRFFFs. Compared with OCRFFFs, FFFs (aOR, 1.77; 95% CI, 1.07-2.91) were associated with a greater risk of fistula after controlling for the number of bone segments and SSI. Both FFFs (aOR, 1.77; 95% CI, 1.27-2.46) and SFFs (aOR, 1.68; 95% CI, 1.05-2.69) were associated with an increased risk of 30-day readmission compared with OCRFFFs after controlling for Charlson-Deyo comorbidity score and acute wound complications. Compared with OCRFFFs, FFFs (aOR, 1.78; 95% CI, 1.25-2.54) and SFFs (aOR, 1.96; 95% CI, 1.22-3.13) were associated with a higher risk of prolonged hospital length of stay after controlling for age and flap loss.
Findings of this cohort study suggest that perioperative outcomes associated with OCRFFFs compare favorably with those of FFFs and SFFs, with shorter operative times and lower rates of flap loss, 30-day readmissions, and prolonged hospital length of stay. However, patients undergoing SFFs represented a more medically and surgically complex population than those undergoing OCRFFFs or FFFs.
比较腓骨游离皮瓣（FFFs）、骨皮桡侧前臂游离皮瓣（OCRFFFs）和肩胛骨游离皮瓣（SFFs）围手术期结果的研究受到样本量不足的限制。
比较接受 FFFs、OCRFFFs 和 SFFs 的患者的围手术期结果。
设计、设置和参与者：这项队列研究评估了 1022 名患者的结果，这些患者在 2005 年 1 月至 2019 年 12 月期间在 6 个学术医疗中心中的 1 个接受了头颈部重建的 FFFs、OCRFFFs 或 SFFs。数据于 2021 年 9 月 17 日至 2022 年 6 月 9 日进行分析。
根据所进行的皮瓣对患者进行分层。评估的围手术期结果包括并发症（总体急性伤口并发症、急性手术部位感染[SSI]、瘘管、血肿和皮瓣失败）、30 天再入院、手术时间和延长住院时间（第 75 百分位数，>13 天）。如果缺失皮瓣类型或临床人口统计学特征的数据，则排除患者。使用逻辑回归分析皮瓣类型与围手术期结果之间的关联，在控制其他临床相关变量后。生成具有 95%置信区间的调整后优势比（aOR）。
对 1022 名（平均[标准差]年龄，60.7[14.5]岁；676[66.1%]名男性）接受主要颌骨头颈部重建的患者的围手术期结果进行了分析；510 例 FFFs（49.9%）、376 例 OCRFFFs（36.8%）和 136 例 SFFs（13.3%）。不同皮瓣类型的中位（IQR）手术时间存在差异（OCRFFF，527[467-591]分钟；FFF，592[507-714]分钟；SFF，691[610-816]分钟）。在控制 SSI 后，FFFs（aOR，2.47；95%CI，1.36-4.51）和 SFFs（aOR，2.95；95%CI，1.37-6.34）与皮瓣丢失的风险增加相关。与 OCRFFFs 相比，FFFs（aOR，1.77；95%CI，1.07-2.91）在控制骨段数量和 SSI 后与瘘管风险增加相关。与 OCRFFFs 相比，FFFs（aOR，1.77；95%CI，1.27-2.46）和 SFFs（aOR，1.68；95%CI，1.05-2.69）在控制 Charlson-Deyo 合并症评分和急性伤口并发症后与 30 天再入院的风险增加相关。与 OCRFFFs 相比，FFFs（aOR，1.78；95%CI，1.25-2.54）和 SFFs（aOR，1.96；95%CI，1.22-3.13）在控制年龄和皮瓣丢失后与延长住院时间的风险增加相关。
这项队列研究的结果表明，与 OCRFFFs 相比，FFFs 和 SFFs 的围手术期结果有利，手术时间较短，皮瓣丢失、30 天再入院和延长住院时间的发生率较低。然而，接受 SFFs 的患者比接受 OCRFFFs 或 FFFs 的患者具有更高的医疗和手术复杂性。
