Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, PR China.
Peking University School of Public Health, Beijing, 100191, China; Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
J Stomatol Oral Maxillofac Surg. 2023 Dec;124(6S):101566. doi: 10.1016/j.jormas.2023.101566. Epub 2023 Jul 23.
Microvascular submandibular gland transplantation (SMGT) for severe dry eye disease (DED) has rarely been reported in the literature. The aim of this study was to report a case series of SMGT with the special focus on monitoring and management of postoperative vascular compromise.
Using a retrospective single-cohort study design, the investigators enrolled a sample of DED patients undergoing SMGT in a Chinese university hospital during 1999 and 2021. The main outcomes were baseline and surgical data, post-operative manifestations, and surgical results. Descriptive, uni- and bivariate statistics were computed with the significant P < 0.05.
During the study period, 220 DED patients (55.9% female) with a mean age of 32.66±14.47 years underwent SMGT. Vascular compromises occurred in 27 grafted glands (12.3%; 22 venous compromises and 5 arterial compromises) at a median of 27 h(range, 3.3 to 288 h) after surgery. Harden texture and swelling of the covering skin flap of the donor indicated venous compromises, while some specific sign was absent for arterial compromise. The accompanying vein of the facial artery (FAV) as a donor's vein was associated with less vascular compromise compared to the anterior facial vein (AFV). Timely reexploration was performed in 25 glands (92.6%), with a salvaged rate of 48%, and more venous compromises were salvaged compared to artery compromises (54.6% vs. 0%, P = 0.047). Temporary hypersecretion on postoperative 2-5 days was noticed in the grafted glands with no or salvaged vascular compromise (Schirmer's test, 35 mm/5 min and 37 mm/5 min, respectively, P = 0.749), while they were absent for the 15 surgically failed grands (Schirmer's test 0 mm/5 min, P<0.001).
Vascular compromise appears to be a common complication of SMGT. Postoperative hypersecretion of the grafted glands may indicate good circulation, and the use of FAV as the donor's vein could help to decrease the risk of vascular compromise.
微血管下颌下腺移植（SMGT）治疗严重干燥性角结膜炎（DED）在文献中鲜有报道。本研究旨在报告一系列 SMGT 病例，重点关注术后血管阻塞的监测和管理。
采用回顾性单队列研究设计，研究人员纳入了 1999 年至 2021 年在中国某大学医院接受 SMGT 的 DED 患者。主要结局为基线和手术数据、术后表现和手术结果。采用描述性、单变量和双变量统计方法，P<0.05 为差异有统计学意义。
研究期间，220 例 DED 患者（55.9%为女性）接受 SMGT，平均年龄为 32.66±14.47 岁。术后中位时间 27 h（范围，3.3 至 288 h）出现 27 个移植腺体血管阻塞（12.3%；22 例静脉阻塞，5 例动脉阻塞）。供体皮瓣质地变硬伴肿胀提示静脉阻塞，而动脉阻塞则无特定体征。与面动脉前静脉（AFV）相比，作为供体静脉的面动脉伴行静脉（FAV）发生血管阻塞的可能性较小。25 个腺体（92.6%）及时进行了再次探查，其中 48%得以挽救，静脉阻塞的挽救率高于动脉阻塞（54.6%比 0%，P=0.047）。在未发生或血管阻塞得以挽救的移植腺体中，术后 2-5 天可见暂时性高分泌（Schirmer 试验，分别为 35mm/5min 和 37mm/5min，P=0.749），而 15 例手术失败的腺体则无高分泌（Schirmer 试验 0mm/5min，P<0.001）。
血管阻塞似乎是 SMGT 的常见并发症。移植腺体的术后高分泌可能表明循环良好，使用 FAV 作为供体静脉可降低血管阻塞的风险。
