Ooms Mark, Winnand Philipp, Heitzer Marius, Vohl Nils, Katz Marie Sophie, Bickenbach Johannes, Hölzle Frank, Modabber Ali
Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Intensive Care Medicine, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Oral Maxillofac Surg. 2025 Apr 21;29(1):85. doi: 10.1007/s10006-025-01378-8.
The influence of blood pressure on microvascular free flap perfusion is not fully understood and remains an ongoing topic of debate, as flap perfusion is both a prerequisite for flap viability and a parameter frequently used for postoperative flap monitoring. The aim of this study was to investigate the influence of blood pressure on microvascular free flap perfusion.
Perfusion measurement data obtained with the Oxygen-2-see (O2C) analysis system intraoperatively and postoperatively in 244 patients who underwent microvascular reconstruction of the head and neck region with a fasciocutaneous free flap (FFF) or perforator free flap (PFF) between 2011 and 2020 were analyzed retrospectively. Blood pressure values (i.e., systolic (SBP), diastolic (DBP), and mean arterial blood pressure (MBP)) and perfusion parameters (i.e., flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation) were evaluated to reveal potential associations.
Postoperative flap blood flow was associated with SBP, DBP, and MBP in PFFs (r = 0.245, p = 0.006; r = 0.239, p = 0.008; r = 0.295, p < 0.001, respectively). These associations also persisted in multivariable analysis (p = 0.036; p = 0.024; p = 0.004, respectively). Postoperative hemoglobin oxygen saturation was associated with SBP and MBP in PFFs (r = 0.253, p = 0.005; r = 0.189, p = 0.036, respectively). The association with SBP also persisted in multivariable analysis (p = 0.005).
Microvascular free flap perfusion in PFFs, specifically postoperative flap blood flow and hemoglobin oxygen saturation, is influenced by blood pressure. This suggests that blood pressure might be an adjustable variable for the control of flap perfusion and should be considered as a confounding variable for flap monitoring based on flap perfusion in PFFs.
血压对游离微血管皮瓣灌注的影响尚未完全明确，仍是一个持续争论的话题，因为皮瓣灌注既是皮瓣存活的前提条件，也是术后皮瓣监测常用的参数。本研究旨在探讨血压对游离微血管皮瓣灌注的影响。
回顾性分析2011年至2020年间244例行头颈部游离筋膜皮瓣（FFF）或穿支游离皮瓣（PFF）微血管重建术患者术中及术后使用Oxygen-2-see（O2C）分析系统获得的灌注测量数据。评估血压值（即收缩压（SBP）、舒张压（DBP）和平均动脉压（MBP））和灌注参数（即皮瓣血流量、血红蛋白浓度和血红蛋白氧饱和度）以揭示潜在关联。
PFFs术后皮瓣血流量与SBP、DBP和MBP相关（r分别为0.245，p = 0.006；r = 0.239，p = 0.008；r = 0.295，p < 0.001）。这些关联在多变量分析中也持续存在（p分别为0.036；p = 0.024；p = 0.004）。PFFs术后血红蛋白氧饱和度与SBP和MBP相关（r分别为0.253，p = 0.005；r = 0.189，p = 0.036）。与SBP的关联在多变量分析中也持续存在（p = 0.005）。
PFFs中游离微血管皮瓣灌注，特别是术后皮瓣血流量和血红蛋白氧饱和度，受血压影响。这表明血压可能是控制皮瓣灌注的一个可调节变量，并且在基于PFFs皮瓣灌注的皮瓣监测中应被视为一个混杂变量。
