Zhou Yi, Zhang Jie, Li Zhenzhen, Wang Xiaodong, Liu Yun, Yang Xudong
Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China; National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China.
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China.
J Stomatol Oral Maxillofac Surg. 2025 Sep 4;127(1):102540. doi: 10.1016/j.jormas.2025.102540.
Maintaining appropriate blood pressure during head and neck free tissue transfer surgery is important for both organ and flap perfusion. However, the use of vasopressors to treat intraoperative hypotension is controversial. The purpose of this prospective cohort study is to evaluate the impact of intraoperative vasopressors on the incidence of flap necrosis.
This prospective cohort study examined patients undergoing free tissue transfer surgery of the head and neck between January 2020 and December 2021 at Peking University School and Hospital of Stomatology. Exclusion criteria included history of preoperative radiotherapy or smoking and American Society of Anesthesiologists (ASA) physical status classification IV or V. The predictor variable was intraoperative vasopressor use and patients were grouped accordingly. The outcome variable was early total flap necrosis(flap failure within 7 days of the operation or before discharge). Univariate logistic regression was used to determine potential risk factors for early flap necrosis. Multivariate regression analyses with sequential adjustment for potential confounding factors was then performed to determine whether these factors were independently associated with flap necrosis. Meanwhile, linear regression analyses were performed with patients stratified according to age and sex to explore the relationship between risk factors and flap outcome.
A total of 239 participants were enrolled, with 121 in the vasopressor group and 118 in the no vasopressor group. Age, ASA classification, Charlson comorbidity index, and flap ischemia duration significantly differed between the groups. Although vasopressor use (odds ratio [OR], 1.65; 95 % confidence interval [CI], 0.39-7.07; P = 0.499) was not significantly associated with flap necrosis in univariate analysis, operation duration (OR, 1.01; 95 % CI, 1.01-1.01; P = 0.001] and flap ischemia duration (OR,1.02; 95 % CI, 1.01-1.03; P = 0.006) were. The smooth curve fitting results demonstrated that both operation duration and flap ischemia duration had a positive linear correlation with flap necrosis.
Use of intraoperative vasopressors during free flap transfer surgery of the head and neck was not associated with early flap failure.
The study was registered with the Chinese Clinical Trial Registry (ChiCTR2100043119).
在头颈部游离组织移植手术中维持适当的血压对器官和皮瓣灌注都很重要。然而，使用血管升压药治疗术中低血压存在争议。这项前瞻性队列研究的目的是评估术中血管升压药对皮瓣坏死发生率的影响。
这项前瞻性队列研究对2020年1月至2021年12月期间在北京大学口腔医学院及口腔医院接受头颈部游离组织移植手术的患者进行了检查。排除标准包括术前放疗或吸烟史以及美国麻醉医师协会（ASA）身体状况分级为IV或V级。预测变量是术中血管升压药的使用情况，并据此对患者进行分组。结果变量是早期皮瓣完全坏死（术后7天内或出院前皮瓣失败）。采用单因素逻辑回归分析确定早期皮瓣坏死的潜在危险因素。然后进行多因素回归分析，并对潜在混杂因素进行序贯调整，以确定这些因素是否与皮瓣坏死独立相关。同时，根据年龄和性别对患者进行分层，进行线性回归分析，以探讨危险因素与皮瓣结局之间的关系。
共纳入239名参与者，血管升压药组121名，非血管升压药组118名。两组在年龄、ASA分级、Charlson合并症指数和皮瓣缺血持续时间方面存在显著差异。虽然在单因素分析中，使用血管升压药（比值比[OR]，1.65；95%置信区间[CI]，0.39 - 7.07；P = 0.499）与皮瓣坏死无显著相关性，但手术持续时间（OR，1.01；95%CI，1.01 - 1.01；P = 0.001）和皮瓣缺血持续时间（OR，1.02；95%CI，1.01 - 1.03；P = 0.006）与皮瓣坏死相关。平滑曲线拟合结果表明，手术持续时间和皮瓣缺血持续时间与皮瓣坏死均呈正线性相关。
头颈部游离皮瓣移植手术中使用术中血管升压药与早期皮瓣失败无关。
该研究已在中国临床试验注册中心注册（ChiCTR2100043119）。
