Evan Rothchild, Neginder Saini, Isabelle T Smith, Jina Yom, Joseph A Ricci
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引用次数: 0
Abstract
Background: Fibula free flap (FFF) surgery complications can arise from vascular disease within the donor peroneal artery. Computed tomography angiography (CTA) has become standard for preoperative evaluation. However, current methods rely on qualitative assessments to determine surgical eligibility. This study aims to improve preoperative risk evaluation by implementing two quantitative scoring systems, the Bollinger score and the lower limb arterial calcification score (LLACS), assessing distinct vascular health components. The Bollinger score quantifies intraluminal stenosis caused by atherosclerotic plaques, while the LLACS quantifies arteriosclerosis by evaluating calcification within the arterial walls.
Methods: A retrospective review was conducted on all head and neck microvascular FFF procedures performed at a university-affiliated tertiary care center between August 2021 and March 2023. Data collected included patient demographics, medical history, operative details, and postoperative complications (infection, hematoma, seroma, fistula, dehiscence, or flap failure) within 90 days. Peroneal artery Bollinger scores and crural segment LLACSs from the donor lower extremity were calculated from preoperative CTAs.
Results: A total of 117 patients were included. Increasing Bollinger scores were significantly associated with an increased risk of complications and longer hospital stays, even after controlling for potential confounders. Combining both scores improved risk stratification, with high-risk patients experiencing an 8.36-fold higher risk of complications.
Conclusion: Our findings suggest that quantitative preoperative peroneal vessel assessment improves risk stratification for patients undergoing FFF surgery. These scoring systems may enhance patient selection and guide strategies to minimize postoperative complications. Integrating multiple scoring systems is key to the comprehensive assessment of vascular health.
期刊介绍：
The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers.
The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases.
The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.
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