Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Otolaryngol Head Neck Surg. 2024 Jul;171(1):63-72. doi: 10.1002/ohn.706. Epub 2024 Mar 19.
Nutritional and inflammatory statuses have been associated with complications in microvascular-free flaps during head and neck surgeries. This study aimed to evaluate the potential of nutritional indicators in predicting postoperative free flap complications.
We conducted a 20-year retrospective, case-control study within a defined cohort.
The study involved head and neck cancer patients from the Chang Gung Research Database who underwent simultaneous tumor ablation and free flap wound reconstruction between January 1, 2001, and December 31, 2019.
We employed logistic regression and stratified analysis to assess the risk of free flap complications and the subsequent need for flap revision or redo in relation to nutritional indicators and other clinical variables.
Of the 8066 patients analyzed, 687 (8.5%) experienced free flap complications. Among these, 197 (2.4%) had free flap failures necessitating a redo of either a free flap or a pedicled flap. Beyond comorbidities such as chronic obstructive pulmonary disease, end-stage renal disease, and a history of prior radiotherapy, every 10-unit decrease in the preoperative prognostic nutritional index (PNI) was consistently associated with an increased risk of both free flap complications and failure. The covariate-adjusted odds ratios were 1.90 (95% confidence interval [CI]: 1.42-2.54) and 1.89 (95% CI: 1.13-3.17), respectively.
A lower preoperative PNI suggests a higher likelihood of microvascular free flap complications in head and neck surgeries. Further randomized controlled trial designs are required to establish causality.
营养和炎症状态与头颈部手术中游离皮瓣的并发症有关。本研究旨在评估营养指标在预测游离皮瓣术后并发症方面的潜力。
我们在一个确定的队列中进行了一项为期 20 年的回顾性病例对照研究。
该研究涉及来自长庚研究数据库的头颈部癌症患者，他们在 2001 年 1 月 1 日至 2019 年 12 月 31 日期间接受了同期肿瘤消融和游离皮瓣创面重建。
我们采用逻辑回归和分层分析来评估游离皮瓣并发症的风险以及与营养指标和其他临床变量相关的皮瓣修复或再修复的后续需要。
在 8066 名患者中，有 687 名（8.5%）发生了游离皮瓣并发症。其中，有 197 名（2.4%）游离皮瓣失败，需要再次进行游离皮瓣或带蒂皮瓣修复。除了慢性阻塞性肺疾病、终末期肾病和先前放疗史等合并症外，术前预测营养指数（PNI）每降低 10 个单位，游离皮瓣并发症和失败的风险都会增加。协变量调整后的优势比分别为 1.90（95%置信区间[CI]：1.42-2.54）和 1.89（95% CI：1.13-3.17）。
术前 PNI 较低提示头颈部手术中游离皮瓣并发症的可能性较高。需要进一步的随机对照试验设计来确定因果关系。
