Allam Omar, Shah Rema, Cadwell Joshua B, Dinis Jacob, Peck Connor, Junn Alexandra, Gowda Arvind, Alperovich Michael
Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
Department of Surgery, Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
J Indian Assoc Pediatr Surg. 2022 Jul-Aug;27(4):428-434. doi: 10.4103/jiaps.jiaps_129_21. Epub 2022 Jul 26.
While there is extensive literature investigating surgical outcomes in free flaps for adults, there is a dearth of information on the efficacy of flap use in the pediatric population. This study is the first to measure complication rates following pediatric free flap reconstruction on a national level.
All pediatric free flap cases between 2012 and 2018 were identified and stratified by type of flap using current procedural terminology codes assigned to the primary procedure in the National Surgical Quality Improvement Program database. Each entry included the recipient location of the flap, postoperative complications, and demographics. Chi-square analysis was used to compare complication rates across various flap groupings. In addition, univariate and multivariate analyses were used to identify independent predictors of flap complications or failure.
Multivariate regression analysis demonstrated that compared to bone flaps, there is increased risk of nonbleeding complications in skin (Odds Ratio (OR) =7.7, = 0.029), muscle (OR = 10.6, = 0.012), and osteocutaneous flaps (OR = 10.8, = 0.018). Flap of the trunk (OR = 40.9, = 0.003) and upper extremities (OR = 32.9, = 0.041) had a higher odds of bleeding complications compared to head-and-neck flaps. Regression analysis also showed that older age is associated with bleeding complications, with patients aged 5-11 years (OR = 38.5, = 0.027) and 12-17 years (OR = 30.6, = 0.038) having greater rates compared to patients under the age of 2. The pediatric flap reoperation rate was found to be 3.6%-4.7%, with the highest flap anastomotic complication rate in the head-and-neck region (6.9%-8.0%).
Free flap reconstruction across flap type, anatomic location, and age ranges are safe and efficacious in the pediatric population.
虽然有大量文献研究成人游离皮瓣的手术效果，但关于皮瓣在儿科人群中使用效果的信息却很匮乏。本研究首次在全国范围内对儿科游离皮瓣重建术后的并发症发生率进行了测量。
利用国家外科质量改进计划数据库中分配给主要手术的当前手术术语代码，识别2012年至2018年间所有儿科游离皮瓣病例，并按皮瓣类型进行分层。每个条目包括皮瓣的受区位置、术后并发症和人口统计学信息。采用卡方分析比较不同皮瓣分组的并发症发生率。此外，还采用单因素和多因素分析来确定皮瓣并发症或失败的独立预测因素。
多因素回归分析表明，与骨瓣相比，皮肤瓣（比值比（OR）=7.7，P = 0.029）、肌肉瓣（OR = 10.6，P = 0.012）和骨皮瓣（OR = 10.8，P = 0.018）发生非出血性并发症的风险增加。与头颈部皮瓣相比，躯干皮瓣（OR = 40.9，P = 0.003）和上肢皮瓣（OR = 3,29，P = 0.041）发生出血性并发症的几率更高。回归分析还显示，年龄较大与出血性并发症相关，5至11岁（OR = 38.5，P = 0.027）和12至17岁（OR = 30.6，P = 0.038）的患者发生率高于2岁以下患者。儿科皮瓣再次手术率为3.6%-4.7%，头颈部皮瓣吻合口并发症发生率最高（6.9%-8.0%）。
在儿科人群中，跨皮瓣类型、解剖位置和年龄范围的游离皮瓣重建是安全有效的。
