Delay of Free Flap Failure at a Single Institution-A Retrospective Case Series and Literature Review

自由游離皮瓣延遲壞死探討──單一醫學中心病例系列研究及文獻回顧

Wei-Yu Chen(陳威宇) ； Meng-Ta Chen(陳孟達) ； Meng-Chien Willie Hsieh(謝孟謙) ； Yur-Ren Kuo(郭耀仁) ； Shu-Hung Huang(黃書鴻)

《臺灣整形外科醫學會雜誌》 32卷4期 (2023/12) Pp. 364-371

摘要

Background: Advancements in microsurgery have propelled free flaps to become a reliable method for reconstructing complex defects. Even though the survival rate for free flap surgeries is reported to be above 95%, flap failures still cannot be avoided. Acute free flap failures usually occur 48 to 72 hours after the operation. Factors of delayed flap failure have not yet been fully investigated. Aim and Objectives: Herein, we present cases of free flap failures that occurred 72 hours postoperatively. Patient demographics, flap donor sites, and causes of flap failure amongst the studied patients were compared. Materials and Methods: We screened all patients who underwent free flap surgery subsequently experienced delayed flap failure from 2012 to 2020 at Kaohsiung Medical University Hospital. Delayed flap failure is defined as failure occurring later than 72 hours after operation. The patient's characteristics, previous chemotherapy or radiotherapy, chronic disease, and type of free flap surgery performed were reviewed retrospectively. Results: A total of 2006 patients having received free tissue transfer was identified. Amongst these, 16 (0.8%) experienced late flap failure, with the median time of flap loss being 9 days and the main cause being vascular compromise. Conclusion: In this study, the major cause of delayed flap failure was vascular compromise and the median time of flap loss was 9 days. Flap viability was determined to be affected by many predisposing factors including hypertension, diabetes mellitus and smoking history; accordingly, patients with the aforementioned factors should be closely monitored for the flap condition even after being discharged from the hospital.

關鍵字

free flap ； free tissue transfer ； delay free flap failure ； reconstruction

並列摘要

背景：顯微手術技術的進步使得自由游離皮瓣更便於用在重建複雜性的缺損。儘管手術的成功率大於95%，但皮瓣壞死仍無法完全避免。急性的壞死一般發生在術後48－72小時內，延遲性壞死的原因尚未被明確地評估。目的及目標：為了評估延遲性壞死的原因，我們蒐集了術後72小時皮瓣壞死的病人，比較這些病人的特性、取皮瓣的位置及造成壞死的原因。材料及方法：本文蒐集了本院2012年至2020年接受游離皮瓣手術的病人。皮瓣延遲性壞死定義為發生於超過術後72小時並分析患者的特性、慢性疾病、是否接受過化學治療或放射治療及皮瓣的種類。結果：共2006位病人接受自由游離皮瓣手術，16位（0.8%）病人有皮瓣延遲性壞死的狀況，而皮瓣壞死時間的中位數為術後9天，且壞死的主要原因是血管受到壓迫導致。結論：游離皮瓣壞死的原因除了血管受到壓迫導致外，若病人有高血壓、糖尿病及抽菸病史也會有較高的風險，因此這些病人需較密切監測皮瓣的狀況。