Risk factors for vascular crisis in free flaps reconstruction of oral and maxillofacial defects.

Abstract

Abstract:

Abstract：Objective To investigate the risk factors for vascular crisis in free flaps reconstruction of oral and maxillofacial defects. Methods Clinical data of 451 free revascularized flaps in 451 patients performed in our department from December 2000 to October 2013 were reviewed. Statistical analysis was done using SPSS statistical software （SPSS for Windows Version17.0）. Univariate statistical analysis was performed to analyze the factors predicting vessel crisis using χ2 and 2-tailed t test methods. For those factors showing statistical significance on univariate analysis （P＜0.05），multivariate logistical regression analysis was then undertaken. Results Forty-three flaps developed vascular crisis （9.53%）， most of which were caused by venous crisis （33/43）. Forty flaps were explored with 22 flaps successfully salvaged， and the success rate was as high as 55%. Univariate analysis showed that end-to-side venous anastomosis and preoperative radiotherapy were of statistical significance （P＜0.05）， but multivariate logistic regression analysis showed that only end-to-side venous anastomosis was of statistical significance. Conclusion The surgical exploration should be done as soon as possible after vascular crisis occurs to get a higher success rate. End-to-side venous anastomosis may be a risk factor in free tissue transfer.

Key words: free flaps, vascular crisis, reconstruction, risk factors

摘要：

目的探讨口腔颌面部游离组织瓣血管危象的危险因素。方法对中山大学光华口腔医学院·附属口腔医院颌面外科2000年12月至2013年10月完成游离组织瓣移植手术的451例患者临床资料进行回顾性研究，采用SPSS17.0统计软件对可能造成血管危象的因素分布进行单因素分析（t和χ2检验），对于有统计学意义者（P＜0.05）进行多因素logistic回归分析。结果本组患者均为单块组织瓣修复，共采用8种游离组织瓣，合计451块，包括前臂皮瓣、腓骨肌皮瓣、股前外侧皮瓣、上臂外侧皮瓣、腹直肌皮瓣（脐旁皮瓣）、髂骨肌皮瓣、背阔肌皮瓣、股前内侧皮瓣。术后43例发生危象，占9.53%，以静脉危象为主（33/43）。其中对40例行手术探查，22例抢救成功，占55%。单因素分析显示静脉吻合方式以及术前放疗有统计学意义（P＜0.05）。经多因素logistic回归分析，只有静脉吻合方式有统计学意义（P＜0.05，OR值为3.633）。结论游离组织瓣一旦出现危象，应积极手术探查，可获得较高的抢救成功率。静脉端侧吻合是游离组织瓣发生血管危象的危险因素。

关键词: 游离组织瓣, 血管危象, 修复重建, 危险因素

CLC Number:

Ｒ78

ZHANG Guo-run， SU Yu-xiong， LIANG Yu-jie， ZHENG Guang-sen， LIAO Gui-qing. Risk factors for vascular crisis in free flaps reconstruction of oral and maxillofacial defects.[J]. Acta Metallurgica Sinica.

张国润，苏宇雄，梁玉洁，郑广森，廖贵清. 口腔颌面部游离组织瓣血管危象危险因素分析[J]. 中国实用口腔科杂志.

References

［1］ Eckardt A， Meyer A， Laas U， et al. Reconstruction of defects in the head and neck with free flaps： 20 years experience ［J］. Br J Oral Maxillofac Surg， 2007， 45（1）：11-15.

［2］毛驰，俞光岩，彭歆，等. 50例口腔颌面部游离前臂皮瓣移植的临床分析［J］. 现代口腔医学杂志， 2002，16（2）：138-140.

［3］ Kesting MR， Hölzle F， Wales C， et al. Microsurgical reconstruction of the oral cavity with free flaps from the anterolateral thigh and the radial forearm： a comparison of perioperative data from 161 cases ［J］. Ann Surg Oncol， 2011， 18（7）：1988-1994.

［4］ Corbitt C， Skoracki RJ， Yu P， et al. Free flap failure in head and neck reconstruction ［J］. Head Neck， 2013. doi： 10.1002/hed.23471. ［Epub ahead of print］

［5］张陈平，张志愿，邱蔚六，等. 口腔颌面部缺损的修复重建—1973例临床分析［J］. 中国修复重建外科杂志， 2005，19（10）：773-776.

［6］叶为民，张志愿，竺涵光，等. 口腔颌面部游离组织瓣危象的观察和处理：附44例报告［J］. 上海口腔医学， 2004，13（2）：91-94.

［7］卢明星，杨旭东，王育新，等. 头颈部游离组织瓣血管危象的预防和处理［J］. 口腔医学研究， 2010，26（2）：243-245.

［8］ Nakatsuka T， Harii K， Asato H， et al. Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection ［J］. J Reconstr Microsurg， 2003，19（6）：363-368， discussion 369.

［9］ Kruse AL， Luebbers HT， Gratz KW， et al. Factors influencing survival of free-flap in reconstruction for cancer of the head and neck： a literature review ［J］.2010， 30（3）：242-248.

［10］ Pattani KM， Byrne P， Boahene K， et al. What makes a good flap go bad? A critical analysis of the literature of intraoperative factors related to free flap failure ［J］.Laryngoscope， 2010， 120（4）：717-723.

［11］ Valentini V， Cassoni A， Marianetti TM， et al. Diabetes as main risk factor in head and neck reconstructive surgery with free flaps ［J］. J Craniofac Surg， 2008， 19（4）：1080-1084.

［12］ Yoshimoto S， Kawabata K， Mitani H. Factors involved in free flap thrombosis after reconstructive surgery for head and neck cancer ［J］. Auris Nasus Larynx， 2010， 37（2）：212-216.

［13］ Rosenberg AJ， Van Cann EM， van der Bilt A， et al. A prospective study on prognostic factors for free-flap reconstructions of head and neck defects ［J］. Int J Oral Maxillofac Surg， 2009， 38（6）：666-670.

［14］ Yazar S. Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects ［J］. Microsurgery， 2007， 27（7）：588-594.

［15］ Dassonville O， Poissonnet G， Chamorey E， et al. Head and neck reconstruction with free flaps： a report on 213 cases ［J］. Eur Arch Otorhinolaryngol， 2008， 265（1）：85-95.

［16］ Suh JD， Sercarz JA， Abemayor E， et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction［J］. Arch Otolaryngol Head Neck Surg， 2004， 130（8）：962-966.

［17］ Albertengo JB， Rodriguez A， Buncke HJ， et al. A comparative study of flap survival rates in end-to-end and end-to-side microvascular anastomosis［J］. Plast Reconstr Surg， 1981， 67（2）：194-199.

［18］ Miyamoto S， Takushima A， Okazaki M， et al. Comparative study of different combinations of microvascular anastomosis types in a rat vasospasm model： versatility of end-to-side venous anastomosis in free tissue transfer for extremity reconstruction ［J］. J Trauma， 2009， 66（3）：831-834.

［19］ Ueda K， Harii K， Nakatsuka T， et al. Comparison of end-to-end and end-to-side venous anastomosis in free-tissue transfer following resection of head and neck tumors［J］. Microsurgery， 1996， 17（3）：146-149.

［20］ Piazza C， Taglietti V， Paderno A， et al. End-to-end versus end-to-side venous microanastomoses in head and neck reconstruction ［J］. Eur Arch Otorhinolaryngol， 2014，271（1）：157-162.

［21］ Cappiello J， Piazza C， Berlucchi M， et al. Internal jugular vein patency after lateral neck dissection： a prospective study ［J］. Eur Arch Otorhinolaryngol， 2002， 259（8）：409-412.

［22］ de Bree R， van den Berg FG， van Schaik C， et al. Assessment of patency of the internal jugular vein following neck dissection and microvascular flap reconstruction by power Doppler ultrasound［J］. J Laryngol Otol， 2002， 116（8）：622-626.

［23］ Kubo T， Haramoto U， Yano K， et al. Internal jugular vein occlusion in head and neck microsurgical reconstruction［J］. Ann Plast Surg， 2002， 49（5）：490-494.

［24］ Brown DH， Mulholland S， Yoo JH， et al. Internal jugular vein thrombosis following modified neck dissection： implications for head and neck flap reconstruction ［J］. Head Neck， 1998， 20（2）：169-174.

［25］ Wax MK， Quraishi H， Rodman S， et al. Internal jugular vein patency in patients undergoing microvascular reconstruction ［J］. Laryngoscope， 1997， 107（9）：1245-1248.

［26］ Russell N S， Hoving S， Heeneman S， et al. Novel insights into pathological changes in muscular arteries of radiotherapy patients［J］. Radiother Oncol， 2009，92（3）：477-483.

［27］ Schultze-Mosgau S， Grabenbauer GG， Radespiel-Troger M， et al. Vascularization in the transition area between free grafted soft tissues and pre-irradiated graft bed tissues following preoperative radiotherapy in the head and neck region ［J］. Head Neck， 2002， 24（1）：42-51.

［28］ Halle M， Farnebo F. Does previous head and neck irradiation increase vascular complications in free autologous reconstruction? ［J］. Plast Reconstr Surg， 2012， 129（3）：549e-550e.

［29］ Mucke T， Rau A， Weitz J， et al. Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions ［J］. Oral Oncol， 2012， 48（4）：367-371.

［30］ Arce K， Bell RB， Potter JK， et al. Vascularized free tissue transfer for reconstruction of ablative defects in oral and oropharyngeal cancer patients undergoing salvage surgery following concomitant chemoradiation［J］. Int J Oral Maxillofac Surg， 2012，41（6）：733-738.

［31］ Bourget A， Chang JT， Wu DB， et al. Free flap reconstruction in the head and neck region following radiotherapy： a cohort study identifying negative outcome predictors ［J］. Plast Reconstr Surg， 2011， 127（5）：1901-1908.

[1]	. [J]. Chinese Journal of Practical Stomatology, 2021, 14(6): 734-738.
[2]	. [J]. Chinese Journal of Practical Stomatology, 2021, 14(6): 758-761.
[3]	. [J]. Chinese Journal of Practical Stomatology, 2021, 14(5): 519-524.
[4]	. [J]. Chinese Journal of Practical Stomatology, 2021, 14(5): 525-530.
[5]	. [J]. Chinese Journal of Practical Stomatology, 2021, 14(5): 531-535.
[6]	. [J]. Chinese Journal of Practical Stomatology, 2021, 14(5): 536-540.
[7]	. [J]. Chinese Journal of Practical Stomatology, 2021, 14(5): 553-559.
[8]	. [J]. Chinese Journal of Practical Stomatology, 2021, 14(5): 621-628.
[9]	. [J]. Acta Metallurgica Sinica, 2021, 14(3): 333-337.
[10]	. [J]. Acta Metallurgica Sinica, 2021, 14(2): 199-203.
[11]	. [J]. Acta Metallurgica Sinica, 2021, 14(1): 21-2510.19538/j.kq.2021.01.005.
[12]	. [J]. Acta Metallurgica Sinica, 2019, 12(4): 241-244.
[13]	. [J]. Acta Metallurgica Sinica, 2019, 12(1): 6-9.
[14]	. [J]. Acta Metallurgica Sinica, 2018, 11(6): 361-364.
[15]	. [J]. Acta Metallurgica Sinica, 2018, 11(6): 379-381.