Outcomes of One Venous Compared to Two Venous Anastomoses in Microsurgical Head and Neck Reconstruction

探討頭頸部顯微重建手術施行一條或兩條靜脈吻合之結果分析

洪振庭(Chen-Ting Hung) ； 李俊達(Jiunn-Tat Lee) ； 鄭立福(Li-Fu Cheng) ； 吳孟熹(Meng-Si Wu)

《臺灣整形外科醫學會雜誌》 30卷2期 (2021/06) Pp. 68-78

摘要

Background: Free flap microsurgical reconstruction of defects in the head and neck region has become a routine procedure with worldwide acceptance. However, there remains no consensus about whether performing one venous (1V) or two venous (2V) anastomoses provides better outcomes. Aim and Objectives: The aim of this study was to determine whether 1V or 2V anastomoses yields better outcomes and to further discuss the results for different venous drainage systems in head and neck reconstruction. Materials and Methods: This retrospective study enrolled patients who received free flap reconstruction of the head and neck region at Hualien Tzu Chi Hospital from November 2007 to October 2019. Demographic characteristics and perioperative variables were collected. The primary outcomes were flap survival rate, take-back rate, and successful salvage rate for 1V and 2V groups. All cases were divided into four groups based on the venous drainage system(s) used: external jugular vein (EJV) system only, internal jugular vein (IJV) system only, EJV+IJV, and other systems. The impact of each system used on the flap outcomes was then analyzed. Results: In total, 173 cases were included in the study, with 31 cases in the 1V group and 142 cases in the 2V group. No significant differences were noted in preoperative clinical parameters. There were also no significant differences in the prevalence of coronary artery disease, diabetes mellitus, hypertension, and previous radiotherapy and chemotherapy. The flap survival rate was 93.5% in the 1V group, whereas it was 93.7% in the 2V group, with no significant difference. There were also no significant differences in take-back rate (6.5% versus 6.3%; p = 1.000) and the rates of complications such as partial necrosis, dehiscence, and monitor flap necrosis. Flap survival rate was 90.9% in EJV only, 94.7% in IJV only, 94% in EJV-IJV, and 93.3% in other systems. Furthermore, no statistically significant differences were identified in pedicle problems, take-back rate, and complication rates. Conclusion: This single-center study revealed no differences in free flap survival rate and take-back rate between one venous anastomosis and two venous anastomoses. No differences were also noted in terms of the outcomes between different venous drainage systems.

關鍵字

head and neck ； free flap ； venous anastomosis

並列摘要

背景：利用自由皮瓣於頭頸部區域進行傷口重建在現階段已經是一個常規的手術。然而，對於應該進行一條或是兩條靜脈吻合仍然沒有定論。目的及目標：本研究是為了分析對於利用顯微自由皮瓣於頭頸部進行重建時，進行一條或是兩條靜脈吻合何者皮瓣成功率比較好。同時也探討不同的靜脈引流系統，是否也會對皮瓣預後造成影響。材料及方法：回溯性收集花蓮慈濟醫院2007年11月至2019年10月接受頭頸部顯微自由皮瓣重建病患之入出院病歷及手術紀錄等，進一步利用統計學方法進行分析，比較一條及兩條靜脈吻合組別之皮瓣存活率、再次手術率及成功拯救率。另外，也根據不同靜脈引流系統，分成外頸靜脈、內頸靜脈、混合及其他等四組進行結果分析。結果：本次研究共收錄173位病患，其中一條靜脈吻合組有31人，兩條靜脈吻合組有142人。各項術前原發疾病包含冠狀動脈疾病、糖尿病、高血壓及過去接受過電化療的比例在兩組間皆沒有達到統計上顯著的差異。一條靜脈吻合組的皮瓣存活率是93.5%，而兩條靜脈吻合組是93.7%，同樣未達顯著差異。再次手術率是6.5%比上6.3%，各項併發症如皮瓣部分壞死、傷口裂開及監測皮瓣壞死之比例也都未達統計上顯著差異。關於不同靜脈引流系統的分析，外頸靜脈、內頸靜脈及混合三組之皮瓣存活率分別是90.9%、94.7%及94.0%。此外，發生吻合血管栓塞、再次手術及併發症發生的比例在各組間也都沒有達到統計上顯著的差異。結論：本研究結果顯示在頭頸部區域利用自由皮瓣進行重建，進行一條或兩條靜脈吻合，對於皮瓣存活率及再手術率都沒有統計上顯著的差異。此外，靜脈吻合在不同靜脈引流系統也不會對皮瓣預後造成顯著差異。