Kornmann Jonas, Schug Rasmus, Huber Lena, Lammert Anne, Jungbauer Frederic, Affolter Annette, Rotter Nicole, Zaubitzer Lena, Bugia Luis, Beck Grietje, Scherl Claudia
Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of Anaesthesiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
J Surg Oncol. 2025 Oct;132(5):945-958. doi: 10.1002/jso.70067. Epub 2025 Aug 27.
Reconstruction of head and neck defects using free flaps is successful, but complications occur. This study aims to identify factors preventing complications to support clinical decision-making.
Retrospective study for free flap reconstructions (2019 to 2022, tertiary referral center). Univariate and multivariate regression models assessed predictors of complication-free survival (CFS) and odds ratios (OR) measured risk correlations.
Of 125 identified cases, most patients were male (71.8%) with a median age of 66 years (37-93 years). Common complications were wound healing disorders (10.9%), hematoma (10%), total (7.3%) or partial (1.8%) flap necrosis, cardiovascular events (5.5%), and pulmonary artery embolism (4.5%). 30-day CFS was 63%. On multivariable analysis, female gender (HR: 9.4, CI: 2.6-33.5), alcohol abuse (HR: 3.5, CI: 1.4-8.4), N2-3 (HR: 2.4, CI: 1.3-4.4), obesity (HR: 2.1, CI: 0.9-5.1), preoperative anticoagulation (HR: 2.5, CI: 1.1-5.9) were significant prognosticators. Positive factors increasing CFS included high albumin (OR 0.21, p = 0.02), intraoperative i.v. heparin bolus (OR 0.15, p = 0.08), intraoperative catecholamine treatment (OR 0.15, p = 0.009), and nonsmoking (OR 0.18, p = 0.1).
Key preventive measures against complications include optimizing nutritional status and albumin levels, administering intraoperative heparin and catecholamines, and abstaining from alcohol. Females should also be screened for undiagnosed cardiovascular risks.
使用游离皮瓣对头颈部缺损进行重建手术成功率较高，但仍会出现并发症。本研究旨在确定预防并发症的因素，以支持临床决策。
对游离皮瓣重建手术进行回顾性研究（2019年至2022年，三级转诊中心）。单因素和多因素回归模型评估无并发症生存（CFS）的预测因素，比值比（OR）衡量风险相关性。
在125例确诊病例中，大多数患者为男性（71.8%），中位年龄为66岁（37 - 93岁）。常见并发症包括伤口愈合障碍（10.9%）、血肿（10%）、皮瓣全部（7.3%）或部分（1.8%）坏死、心血管事件（5.5%）和肺动脉栓塞（4.5%）。30天无并发症生存率为63%。多因素分析显示，女性（HR：9.4，CI：2.6 - 33.5）、酗酒（HR：3.5，CI：1.4 - 8.4）、N2 - 3期（HR：2.4，CI：1.3 - 4.4）、肥胖（HR：2.1，CI：0.9 - 5.1）、术前抗凝（HR：2.5，CI：1.1 - 5.9）是显著的预后因素。提高无并发症生存率的积极因素包括高白蛋白水平（OR 0.21，p = 0.02）、术中静脉注射肝素推注（OR 0.15，p = 0.08）、术中使用儿茶酚胺治疗（OR 0.15，p = 0.009）和不吸烟（OR 0.18，p = 0.1）。
预防并发症的关键措施包括优化营养状况和白蛋白水平、术中使用肝素和儿茶酚胺以及戒酒。还应对女性进行未确诊心血管风险的筛查。
