Risk Factors of Free Flap Outcomes After Head and Neck Cancer Surgery: A Multivariable Analysis From a Single Center Experience

IF 1.7 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2025-02-08 DOI:10.1002/micr.70023

Chia-Hsuan Tsai, Cristhiam Yang, Yao-Chang Liu, Chi-Ling Chen, Huang-Kai Kao

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引用次数: 0

Abstract

Introduction

Risk factors for unfavorable outcomes, such as surgical site infection (SSI) and flap loss, following free flap reconstruction in patients with head and neck cancer are repeatedly reported without a definitive conclusion. Institutional reviews and meta-analyses each have their advantages and limitations. Although this study is without a definitive answer to these questions, it contributes to the literature by identifying potential influencing factors.

Methods

This single-center cohort study included 596 patients who underwent head and neck reconstruction between 2015 and 2017. Patients were initially divided into two groups based on the presence or absence of SSI, and a similar comparison was made for flap loss. Data were further analyzed using univariate and multivariate logistic regression.

Results

The overall SSI rate was 18.29%, with the age of patients (65–74 years, adjusted OR 2.41, p < 0.001; > 74 years, adjusted OR 3.53, p < 0.001) and segmental mandibulectomy (adjusted OR 1.81, p = 0.035) as independent risk factors. The overall flap failure rate was 4.4%, with medial sural flap (adjusted OR 6.89; p = 0.025) and prolonged operative time per hour (adjusted OR 1.38; p < 0.001) identified as significant influencing factors.

Conclusion

Age should not be the sole determinant for excluding patients for free tissue transfer, though it may elevate the SSI rate. Special attention is potentially needed during postoperative care for patients who received segmental mandibulectomy, medial sural flap, or experienced prolonged operative time. Identifying these risk factors can assist surgeons in optimizing flap outcomes before head and neck reconstruction.

查看原文本刊更多论文

头颈癌手术后游离皮瓣预后的危险因素：单中心经验的多变量分析

头颈癌患者游离皮瓣重建后手术部位感染（SSI）和皮瓣丢失等不良结果的危险因素被反复报道，但没有明确的结论。机构评价和荟萃分析各有其优点和局限性。虽然本研究对这些问题没有明确的答案，但它通过确定潜在的影响因素对文献做出了贡献。方法本研究为单中心队列研究，纳入2015年至2017年接受头颈部重建术的596例患者。患者最初根据是否存在SSI分为两组，并对皮瓣丢失进行类似的比较。采用单因素和多因素logistic回归进一步分析数据。结果SSI总发生率为18.29%，患者年龄为65 ~ 74岁，调整OR为2.41,p < 0.001；>； 74岁，校正OR为3.53,p < 0.001)和分段下颌骨切除术（校正OR为1.81,p = 0.035）为独立危险因素。皮瓣总失败率为4.4%，其中腓肠内侧皮瓣(调整OR为6.89；p = 0.025)和每小时手术时间延长(调整OR为1.38；P < 0.001)被认为是重要的影响因素。结论年龄不应是排除游离组织移植患者的唯一决定因素，尽管年龄可能会提高SSI的发生率。对于接受下颌骨节段性切除术、腓肠内侧皮瓣或手术时间延长的患者，在术后护理中可能需要特别注意。识别这些危险因素可以帮助外科医生在头颈部重建前优化皮瓣的效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.