头颈缺损游离皮瓣修复后的皮瓣坏死因素分析

目的：分析游离皮瓣修复头颈部缺损术后发生皮瓣危象及坏死的原因。方法：回顾性分析680例应用游离皮瓣修复头颈部缺损患者的临床资料，分析皮瓣危象发生及坏死的原因。对患者一般资料、手术医生年资及吻合静脉数等影响预后的因素进行单因素分析，多因素分析采用Logistic回归分析。结果：680例游离皮瓣移植术后出现血管危象58例（8.53％），抢救成功22例，坏死36例，游离皮瓣移植成功率94.70％（644／680）。多因素分析显示，肥胖、吸烟、术前放疗、手术者的年资偏低是影响皮瓣危象发生的独立危险因素（P＜0.05），吻合2根静脉比吻合1根静脉，具有更高的成功率（P＜0.05），而年龄、高血压、糖尿病在本组病例中差异无统计学意义（P＞0.05）。结论：早期发现并及时手术探查是提高皮瓣危象抢救成功率最有效的方法，肥胖、吸烟、术前放疗、手术者的年资偏低及吻合静脉数目是影响游离皮瓣危象发生的独立危险因素，老年患者、高血压及糖尿病并不是游离皮瓣修复头颈部缺损的禁忌证。

Analysis of the risk factors of free flaps necrosis used for reconstruction of head-neck defects

Objective:To analyze the causes of the vascular crisis and necrosis of free flaps used for reconstruction of defects following head and neck cancer resection and the managements of these issues.Methods:The clinical characteristics (age,smoking,obesity,diabetes mellitus,hypertension,preoperative radiotherapy,anastomosed vein number and surgeon’ s experience) of 680 cases head-neck tumors patients who underwent free flaps reconstruction in our hospital from February, 2009 to July,2015 were retrospectively analyzed.The one-factor analysis and a logistic regression model were used to identify key risk factors of vascular crisis and necrosis.Results:Among the 680 transferred flaps,644 cases survived and 36 cases (8.53%) showed necrosis,the overall survival rate was 94.70%.58 flap compromises due to vascular crisis were identified and 22 flaps were salvaged completely after exploration.In multivariate analysis,smoking,obesity,preoperative radiotherapy, anastomosed vein number and surgeon’s experience(all P<0.05),rather than age,diabetes and hypertension(P>0.05) were the independent risk factors of skin flap necrosis.Two-vein anastomosis had a higher success rate than one-vein anasto-mosis(P<0.05).Conclusion:Early detection,re-exploration,and effective handling of the flap crisis increase the rate of flap salvage tremendously.Smoking,obesity,preoperative radiotherapy,anastomosed vein number and surgeon’ s experience are the key risk factors of free flap crisis.Diabetes mellitus,elderly patients and hypertension are not the contraindications for free flap reconstruction of head-neck defects.