失败皮瓣的处理
Management of the Failing Flap.
作者信息
Slijepcevic Allison A, Yang Sara, Petrisor Daniel, Chandra Srinivasa R, Wax Mark K
机构信息
Department of Otolaryngology - HNS, Oregon Health Sciences University, Portland, Oregon.
Department of Oral Maxillofacial Surgery, Oregon Health Sciences University, Portland, Oregon.
出版信息
Semin Plast Surg. 2022 Dec 3;37(1):19-25. doi: 10.1055/s-0042-1759563. eCollection 2023 Feb.
Free tissue transfer has become the reconstructive modality of choice for replacing composite tissue defects. While the success rate in high-volume centers is reported to be greater than 95%, up to 10% of patients will require revision of their vascular anastomosis secondary to thrombosis or compromise to flow. In the intraoperative setting, immediate revision is successful in the majority of cases. Rarely, the flap cannot be revascularized and a secondary option must be used. In the perioperative setting revision is successful if the patient can be brought back to the operating room in a timely fashion. Revision rates up to 70% are reported. A small number of these patients may then suffer a second episode of compromise where revision is less successful at 30%. In these cases, consideration should be given to secondary reconstruction rather than attempting salvage. Finally, there are a small number of patients whose flaps will fail following discharge from the hospital. These patients can rarely be salvaged and secondary reconstructive options should be explored.
游离组织移植已成为修复复合组织缺损的首选重建方式。虽然据报道，大型中心的成功率超过95%，但高达10%的患者因血栓形成或血流受阻，需要对血管吻合进行修复。在术中情况下，大多数病例立即修复是成功的。很少有皮瓣无法再血管化，必须采用第二种选择。在围手术期，如果患者能及时返回手术室，修复是成功的。据报道，修复率高达70%。其中一小部分患者可能会再次出现血流受阻情况，此时修复成功率较低，为30%。在这些情况下，应考虑进行二次重建，而不是尝试挽救。最后，有一小部分患者的皮瓣在出院后会失败。这些患者很少能被挽救，应探索二次重建的选择。
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