Saadoun Rakan, Guerrero David T, Bengur Fuat Baris, Moroni Elizabeth A, Surucu Yusuf, Smith Roy E, Esper Stephen A, Whitehurst Steven L, Artman Jamie, Veit Johannes A, Kubik Mark, Sridharan Shaum, Solari Mario G
Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Faculty of Medicine Mannheim, Ruprecht Karls University Heidelberg, Mannheim, Germany.
JAMA Otolaryngol Head Neck Surg. 2025 Feb 1;151(2):121-127. doi: 10.1001/jamaoto.2024.3964.
Venous thromboembolism (VTE) is a severe complication after microsurgical free tissue transfer (FTT) to the head and neck. Hypothermia during surgery is a modifiable risk factor, and avoiding it may reduce the postoperative VTE rate.
To assess the association between hypothermia (temperature <36 °C) and postoperative VTE and free flap pedicle thrombosis rates after head and neck reconstruction with FTT.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study in a tertiary academic referral center used prospective and retrospective database and medical record data collected for patients who underwent head and neck reconstruction with FTT between January 1, 2012, and August 31, 2023. Temperature over time was classified as normothermia (temperature ≥36 °C), hypothermia (<36 °C) for more than 30 minutes and less than 120 minutes, and hypothermia for 120 minutes or more.
Venous thromboembolism.
The study outcomes were VTE events and thrombosis of the free flap pedicle that required revision surgery. Univariable and multivariable regressions were used to test the association between the outcomes and clinical factors.
A total of 1078 patients (mean [SD] age, 61.3 [12.6] years; 724 males [67.2%]; mean [SD] Caprini score, 6.4 [2.1]) were included. The VTE and pedicle thrombosis rates were 3.2% (35 patients) and 2.2% (24 patients), respectively. In a multivariable model controlled for Caprini score and chemoprophylaxis, VTE was associated with hypothermia of more than 30 minutes and less than 120 minutes (odds ratio [OR], 3.82; 95% CI, 0.99-14.07) and hypothermia of 120 minutes or longer (OR, 3.55; 95% CI, 1.05-11.95). Free flap pedicle thrombosis was not associated with hypothermia (OR, 0.61; 95% CI, 0.26-1.43).
These findings suggest that preventing hypothermia during microsurgical FTT to the head and neck may decrease the postoperative rate of VTE. Future studies should explore the optimal intraoperative body temperature range that may prevent the development of VTE without compromising patient safety.
静脉血栓栓塞症（VTE）是显微外科游离组织移植（FTT）至头颈部后的一种严重并发症。手术期间体温过低是一个可改变的风险因素，避免体温过低可能会降低术后VTE发生率。
评估头颈部重建FTT术后体温过低（体温<36°C）与术后VTE及游离皮瓣蒂部血栓形成率之间的关联。
设计、设置和参与者：这项在三级学术转诊中心进行的回顾性队列研究使用了前瞻性和回顾性数据库以及为2012年1月1日至2023年8月31日期间接受头颈部重建FTT的患者收集的病历数据。随时间变化的体温被分类为正常体温（体温≥36°C）、体温过低（<36°C）超过30分钟且少于120分钟以及体温过低120分钟或更长时间。
静脉血栓栓塞症。
研究结局为VTE事件以及需要翻修手术的游离皮瓣蒂部血栓形成。采用单变量和多变量回归分析来检验结局与临床因素之间的关联。
共纳入1078例患者（平均[标准差]年龄，61.3[12.6]岁；724例男性[67.2%]；平均[标准差]卡普里尼评分，6.4[2.1]）。VTE和蒂部血栓形成率分别为3.2%（35例患者）和2.2%（24例患者）。在控制了卡普里尼评分和化学预防的多变量模型中，VTE与体温过低超过30分钟且少于120分钟（比值比[OR]，3.82；95%置信区间，0.99 - 14.07）以及体温过低120分钟或更长时间（OR，3.55；95%置信区间，1.05 - 11.95）相关。游离皮瓣蒂部血栓形成与体温过低无关（OR，0.61；95%置信区间，0.26 - 1.43）。
这些发现表明，在对头颈部进行显微外科FTT期间预防体温过低可能会降低术后VTE发生率。未来的研究应探索在不影响患者安全的情况下可能预防VTE发生的最佳术中体温范围。
