Rocans Rihards Peteris, Zarins Janis, Bine Evita, Mahauri Insana, Deksnis Renars, Citovica Margarita, Donina Simona, Vanags Indulis, Mamaja Biruta
Intensive Care Clinic, Riga East Clinical University Hospital, Riga, Latvia.
Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Riga, Latvia.
JPRAS Open. 2025 Apr 2;44:414-423. doi: 10.1016/j.jpra.2025.03.022. eCollection 2025 Jun.
Microvascular flap surgery is a widely used procedure for the reconstruction of various defects. Data on laboratory biomarkers for the prediction of flap complications are currently limited. We aimed to investigate the link between preoperative fibrinogen-to-albumin ratio (FAR) and various flap complications.
This prospective cohort study included 130 adult patients who underwent elective microvascular flap surgery. Preoperative blood samples for the analysis of plasma fibrinogen (g/L) and albumin (g/L) were collected on the day of surgery before initiating crystalloid infusion. Post-operative data on various flap complications were obtained.
The overall complication rate was 17.7% with true flap loss occurring in 5.4%. Binary logistic regression revealed that the patients with FAR<0.08 and FAR<0.06 had increased odds of flap hematoma or flap loss (OR 3.68 [1.04-13.03], p=0.044 and 6.01 [1.71-21.08], p=0.005). Patients with FAR>0.10 had increased odds of minor flap complications (OR 5.47 [1.33-22.50], p=0.019). Patients with FAR<0.06 had increased odds of any flap complications (OR 4.71 [1.27-18.03], p=0.021). Patients with FAR>0.10 also had increased odds of any flap complications (OR 3.09 [1.08-8.81], p=0.035), implying a U-shaped link.
Assessment of FAR to estimate the risk of complications has considerable predictive value in microvascular flap surgery. Patients undergoing this surgery can be evaluated to predict their nutrition and coagulation risks and optimize decision-making in their perioperative care.
微血管皮瓣手术是一种广泛用于修复各种缺损的手术方法。目前，关于预测皮瓣并发症的实验室生物标志物的数据有限。我们旨在研究术前纤维蛋白原与白蛋白比值（FAR）与各种皮瓣并发症之间的联系。
这项前瞻性队列研究纳入了130例行择期微血管皮瓣手术的成年患者。在手术当天开始输注晶体液之前采集术前血样，用于分析血浆纤维蛋白原（g/L）和白蛋白（g/L）。获取各种皮瓣并发症的术后数据。
总体并发症发生率为17.7%，真正的皮瓣坏死发生率为5.4%。二元逻辑回归显示，FAR<0.08和FAR<0.06的患者发生皮瓣血肿或皮瓣坏死的几率增加（比值比[OR]3.68[1.04 - 13.03]，p = 0.044；OR 6.01[1.71 - 21.08]，p = 0.005）。FAR>0.10的患者发生轻微皮瓣并发症的几率增加（OR 5.47[1.33 - 22.50]，p = 0.019）。FAR<0.06的患者发生任何皮瓣并发症的几率增加（OR 4.71[1.27 - 18.03]，p = 0.021）。FAR>0.10的患者发生任何皮瓣并发症的几率也增加（OR 3.09[1.08 - 8.81]，p = 0.035），这意味着呈U形联系。
评估FAR以估计并发症风险在微血管皮瓣手术中具有相当大的预测价值。可以对接受该手术的患者进行评估，以预测其营养和凝血风险，并优化围手术期护理的决策。
