Kroll S S, Schusterman M A, Reece G P, Miller M J, Evans G R, Robb G L, Baldwin B J
Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, USA.
Plast Reconstr Surg. 1996 Dec;98(7):1230-3. doi: 10.1097/00006534-199612000-00017.
A series of 990 consecutive free flaps was reviewed to determine how often pedicle thrombosis occurred, when it occurred, and if the timing of thrombosis detection had any relationship to the probability of flap salvage. The overall thrombosis rate was 5.1 percent, and the flap loss rate was 3.2 percent. The majority (80 percent) of thrombi occurred within the first 2 postoperative days. Only 5 thrombi (10 percent) were known to have occurred after the third postoperative day. No flaps that developed thrombosis after the third postoperative day were salvaged successfully. Had flap monitoring been discontinued after the first 3 postoperative days, our results in this series would have been unchanged. Thrombosis of the vein (54 percent) was more common than arterial thrombosis (20 percent) or thrombosis of both artery and vein (12 percent). Almost all purely arterial thrombi (90 percent) occurred before the end of the first postoperative day, whereas 41 percent of all venous thrombi occurred later. We conclude that arterial monitoring is most critical immediately after surgery. Beginning on the second postoperative day, venous monitoring becomes progressively more important to flap success. The cost-effectiveness of postoperative monitoring of free flaps is greatest during the first 2 days, after which it decreases significantly.
回顾了连续990例游离皮瓣，以确定蒂部血栓形成的发生率、发生时间，以及血栓检测时间与皮瓣挽救概率之间是否存在关联。总体血栓形成率为5.1%，皮瓣丢失率为3.2%。大多数血栓（80%）发生在术后头2天内。已知只有5例血栓（10%）发生在术后第3天之后。术后第3天之后发生血栓形成的皮瓣无一成功挽救。如果术后头3天之后停止皮瓣监测，本系列研究结果不会改变。静脉血栓形成（54%）比动脉血栓形成（20%）或动静脉均发生血栓形成（12%）更常见。几乎所有单纯动脉血栓（90%）都发生在术后第1天结束之前，而所有静脉血栓中有41%发生在较晚时间。我们得出结论，术后立即进行动脉监测最为关键。从术后第2天开始，静脉监测对皮瓣成功逐渐变得更加重要。游离皮瓣术后监测的成本效益在头2天内最大，此后显著降低。
