Cumulative risk factors for flap failure, thrombosis, and hematoma in free flap reconstruction for head and neck cancer: a retrospective nested case-control study.

IF 12.5 2区医学 Q1 SURGERY

International journal of surgery Pub Date : 2024-09-05 DOI:10.1097/JS9.0000000000002069

Pei-Hsin Hsiung, Ho-Yin Huang, Wei-Yu Chen, Yur-Ren Kuo, Ying-Chi Lin

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引用次数: 0

Abstract

Background: Free flap construction enhances quality of life for head and neck cancer (HNC) patients; however, complications, such as thrombosis and hematoma, threaten flap survival. This study aimed to identify factors influencing flap failure, thrombosis, and hematoma.

Methods: A retrospective nested case-control study was conducted on HNC patients who underwent free flap reconstruction at a tertiary medical center between January 2019 and January 2022. All patients received antithrombotic prophylaxis consisting of prostaglandin E1, dextran, aspirin, and dipyridamole. Risk factors were analyzed using multivariate logistic regression.

Results: Among 548 flaps analyzed, flap failure, thrombosis, and hematoma rates were 4.74%, 3.83%, and 9.65%, respectively. Risk factors for flap failure included thrombosis (OR 86.42, 95% CI 15.73-474.89), smoking (OR 49.44, 95% CI 1.28->1000), posteromedial thigh (PMT) flap usage (OR 14.05, 95% CI 2.48-79.54), hematoma (OR 9.68, 95% CI 2.35-39.79), and younger age (OR 0.93, 95% CI 0.87-0.99). Thrombosis risk factors included PMT usage (OR 11.45, 95% CI 2.60-50.38) and anastomosis with the superior thyroid vein (SThV) as the recipient vein after multiple reconstructions (OR 7.91, 95% CI 2.06-30.39). Hematoma risk factors included fibula osteocutaneous flap usage (OR 9.22, 95% CI 2.71-31.42), double-flap usage (OR 8.88, 95% CI 1.80-43.81), liver cirrhosis (OR 6.28, 95% CI 1.44-27.47), and postsurgery hypertension (OR 2.77, 95% CI 1.39-5.50), whereas ipsilateral recurrence (OR 0.14, 95% CI 0.03-0.73) and using the external jugular vein (EJV) as the recipient vein (OR 0.22, 95% CI 0.08-0.61) were protective factors.

Conclusion: Thrombosis poses a greater risk than hematoma for flap failure. Utilization of the PMT flap and the SThV markedly increased the risk of thrombosis and flap failure. These findings highlight the importance of antithrombotic prophylaxis and the selection of flaps and recipient veins in recurrent HNC patients.

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头颈癌游离皮瓣重建术中皮瓣失败、血栓形成和血肿的累积风险因素：一项回顾性巢式病例对照研究。

背景：游离皮瓣可提高头颈癌（HNC）患者的生活质量，但血栓和血肿等并发症威胁着皮瓣的存活。本研究旨在确定影响皮瓣失败、血栓形成和血肿的因素：方法：对2019年1月至2022年1月期间在一家三级医疗中心接受游离皮瓣重建术的HNC患者进行了一项回顾性巢式病例对照研究。所有患者均接受了抗血栓预防治疗，包括前列腺素 E1、右旋糖酐、阿司匹林和双嘧达莫。使用多变量逻辑回归分析了风险因素：在分析的 548 个皮瓣中，皮瓣失败率、血栓形成率和血肿形成率分别为 4.74%、3.83% 和 9.65%。皮瓣失败的风险因素包括血栓形成（OR 86.42，95% CI 15.73-474.89）、吸烟（OR 49.44，95% CI 1.28->1000）、使用大腿后内侧（PMT）皮瓣（OR 14.05，95% CI 2.48-79.54）、血肿（OR 9.68，95% CI 2.35-39.79）和年龄较小（OR 0.93，95% CI 0.87-0.99）。血栓风险因素包括使用 PMT（OR 11.45，95% CI 2.60-50.38）和多次重建后以甲状腺上静脉（STHV）作为受体静脉进行吻合（OR 7.91，95% CI 2.06-30.39）。血肿风险因素包括使用腓骨骨皮瓣（OR 9.22，95% CI 2.71-31.42）、使用双瓣（OR 8.88，95% CI 1.80-43.81）、肝硬化（OR 6.28，95% CI 1.44-27.47）和术后高血压（OR 2.77，95% CI 1.39-5.50），而同侧复发（OR 0.14，95% CI 0.03-0.73）和使用颈外静脉（EJV）作为受体静脉（OR 0.22，95% CI 0.08-0.61）是保护因素：结论：与血肿相比，血栓形成对皮瓣失败的风险更大。结论：血栓形成比血肿更容易导致皮瓣失败。使用PMT皮瓣和SThV明显增加了血栓形成和皮瓣失败的风险。这些发现强调了抗血栓预防以及选择皮瓣和受体静脉对复发性 HNC 患者的重要性。

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来源期刊

International journal of surgery SURGERY-

CiteScore

17.70

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.