Pabst Andreas, Zeller Alexander-N, Raguse Jan Dirk, Hoffmann Jürgen, Goetze Elisabeth
Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany.
Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
J Craniomaxillofac Surg. 2023 Feb;51(2):71-78. doi: 10.1016/j.jcms.2023.02.003. Epub 2023 Feb 20.
This study aimed to evaluate the use of microvascular free flaps (MFF) in oral and maxillofacial surgery (OMFS) in Germany, Austria, and Switzerland. A dynamic online questionnaire, using 42-46 questions, was sent to OMF surgeons based in hospitals in Germany, Austria, and Switzerland. The questionnaire was evaluated internally and externally. Aside from general information, data were collected on organizational aspects, approaches, MFF types and frequency, presurgical planning, intraoperative procedures, perioperative medications, flap monitoring, and patient management. Participants mostly performed 30-40 MFF each year (11/53). Most stated that the COVID-19 pandemic did influence MFF frequency (25/53) to varying extents. Radial forearm flap was most frequently used (37/53), followed by ALT (5/53), and fibula flap (5/53). Primary reconstruction was performed by most participants (35/48). Irradiated bony transplants were mostly used for implant placement after 12 months (23/48). Most participants (38/48) used reconstruction plates, followed by miniplates (36/48), PSI reconstruction (31/48), and PSI miniplates (10/48). Regarding the postoperative use of anticoagulants, low-molecular-weight (37/48) and unfractioned heparins (15/48) were widely used, most often for 3-7 days (26/48). Clinical evaluation was mostly preferred for flap monitoring (47/48), usually every 2 h (34/48), for at least 48 h (19/48). Strong heterogeneity in MFF reconstructions in OMFS was found, especially regarding the timepoints of reconstruction, types of osteosynthesis, and postoperative MFF management. These findings provide the chance to further compare the different treatment algorithms regarding relevant MFF aspects, such as postoperative management. This could create evidence-based treatment algorithms that will further improve the clinical outcomes in MFF reconstructions.
本研究旨在评估德国、奥地利和瑞士口腔颌面外科（OMFS）中游离微血管皮瓣（MFF）的使用情况。一份包含42 - 46个问题的动态在线问卷被发送给德国、奥地利和瑞士医院的口腔颌面外科医生。该问卷进行了内部和外部评估。除一般信息外，还收集了关于组织方面、手术方法、MFF类型和频率、术前规划、术中操作、围手术期用药、皮瓣监测和患者管理的数据。参与者每年大多进行30 - 40例MFF手术（11/53）。大多数人表示，新冠疫情确实在不同程度上影响了MFF的频率（25/53）。最常使用的是桡侧前臂皮瓣（37/53），其次是股前外侧皮瓣（ALT，5/53）和腓骨皮瓣（5/53）。大多数参与者进行了一期重建（35/48）。照射后的骨移植大多在12个月后用于种植体植入（23/48）。大多数参与者（38/48）使用重建钢板，其次是微型钢板（36/48）、个性化手术导板（PSI）重建（31/48）和PSI微型钢板（10/48）。关于术后抗凝剂的使用，低分子量肝素（37/48）和普通肝素（15/48）被广泛使用，最常使用3 - 7天（26/48）。皮瓣监测大多首选临床评估（47/48），通常每2小时进行一次（34/48），至少持续48小时（19/48）。在口腔颌面外科的MFF重建中发现了很强的异质性，特别是在重建时间点、骨固定类型和术后MFF管理方面。这些发现为进一步比较MFF相关方面（如术后管理）的不同治疗算法提供了机会。这可以创建基于证据的治疗算法，进一步改善MFF重建的临床结果。
