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1.
J Plast Reconstr Aesthet Surg ; 85: 500-507, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37603985

RESUMO

BACKGROUND: The association between successful reconstructive surgery with a free flap and hospital volume has not been well established. This study was designed to retrospectively analyze the outcome of free-flap surgery registered in a nationwide surgical registration system in Japan to clarify the relationship between free-flap survival and facilities' average annual number of free-flap surgeries. METHODS: We analyzed data from 19,482 free flaps performed during 2017-2020 at 407 facilities throughout Japan. After adjusting for sex, age, and disease classification that differ between the groups, we examined the differences in the flap survival rates among the different facilities in terms of the average number of free-flap surgeries performed annually. RESULTS: The total overall necrosis rate was 2.8%. Of all procedures, 14.9%, 12.9%, 33.4%, and 38.8% were performed at facilities with an average number of free-flap procedures <10, 10-19, 20-49, and ≥ 50 per year, respectively, and the respective rates of total necrosis were 6.0%, 3.8%, 2.1%, and 1.7%, respectively. The odds ratios and 95% confidence intervals of flap necrosis for facilities with ≥ 50 cases per year relative to those <10 were 2.70 (1.98-3.68) for nonbreast reconstruction cases and 5.72 (2.77-11.8) for breast reconstruction cases. CONCLUSION: This analysis of a nationwide plastic surgery database showed that free-flap surgeries in institutions with a low average annual number of free-flap surgeries had a higher risk of total necrosis. Measures should be taken to either aggregate cases into high-volume centers or improve management at low-volume centers.


Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Necrose , Complicações Pós-Operatórias/epidemiologia
2.
Laryngoscope ; 129(8): 1915-1921, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30152141

RESUMO

OBJECTIVES: The objective of this study was to identify the factors that influence free flap survival after head and neck reconstructive surgery in pediatric patients. METHODS: One hundred thirty consecutive cases of head and neck reconstruction with free flaps in pediatric patients at the Department of Oral and Maxillofacial Surgery at Peking University School and Hospital of Stomatology, Beijing, People's Republic of China, between 1999 and 2017 were reviewed. A single head and neck surgical team performed all the included surgeries. Demographic and surgical patient data with possible associations with free flap survival were recorded. Relevant influencing factors were determined using the χ2 test and logistic regression analysis. RESULTS: There were 135 free flap transfers performed in the patients, with an overall success rate of 95.6%. Free flap failure occurred in six flaps (4.4%). Arterial crisis was the main cause of flap failure. The overall complication rate was 7.0%. Patient age (5-9 years old; odds ratio, 13.397; 95% confidence interval, 1.167-153.838; P = 0.037) was a statistically significant risk factor influencing free flap survival. Donor site, defect region, recipient vessel, and surgery time were not associated with free flap outcome. CONCLUSION: Free flap transfer for head and neck reconstruction in pediatric patients is safe and reliable. However, special attention should be paid to pediatric patients under 9 years of age when performing head and neck reconstruction. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1915-1921, 2019.


Assuntos
Retalhos de Tecido Biológico/fisiologia , Sobrevivência de Enxerto/fisiologia , Cabeça/cirurgia , Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Retalhos de Tecido Biológico/transplante , Humanos , Masculino , Resultado do Tratamento
3.
Br J Oral Maxillofac Surg ; 56(4): 310-314, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29555139

RESUMO

Venous congestion results in tissue damage and remains the most common reason for failure of transfer of microvascular free flaps if it is not recognised early. The purpose of this study was to measure the critical duration of venous congestion and the resultant survival of flaps according to the duration of venous stasis. A standard epigastric flap was raised and repositioned in 35 rats, seven of which acted as controls. The superficial inferior epigastric vein was fully occluded for four, five, six, or seven hours in the rest (n=7 each group). Subsequently, the rats were monitored for one week, and the resultant necrotic areas were photographed. After five, six, and seven hours of venous stasis, the incidence and area of necrosis were significantly increased (p=0.04 in each) above that of the control. The degree of necrosis after seven hours of venous stasis was significantly greater than that after four or five hours (p=0.01 and 0.02, respectively). The duration of venous congestion is therefore a potential risk for the survival of free flaps, as it results in operative complications and may jeopardise the whole procedure. After a critical period of venous stasis we reach a point of no return, and any attempt to salvage the compromised flap will be in vain. Based on these results, we think that monitoring by an experienced surgeon at intervals of no longer than three hours is essential for the successful salvage of venous congestion in microvascular free flaps.


Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Sobrevivência de Enxerto , Hiperemia/complicações , Abdome/cirurgia , Animais , Fluxômetros , Retalhos de Tecido Biológico/patologia , Necrose , Ratos , Transplante de Pele/efeitos adversos , Transplante de Pele/métodos
4.
J Plast Reconstr Aesthet Surg ; 67(5): 624-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24581954

RESUMO

BACKGROUND: The limb-threatening large soft tissue defects that occur on the feet of type 2 diabetic patients have complex causes and are less likely to be corrected by free flap reconstruction compared to those in non-diabetic patients. We retrospectively analysed factors affecting the success of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes. METHODS: This study included 33 diabetic patients whose feet were treated with free flap transfers. All patients had limb-threatening large soft tissue defects with tendon or bone exposure. The operative results were divided into three groups at 1 month post-operatively: the complete healing group, and the complication group, with either partial necrosis requiring additional simple procedures or flap failure with total necrosis. Nine preoperative factors were analysed: (1) ankle brachial index, (2) HbA1c, (3) BMI, (4) the smoking factor, (5) atherosclerotic calcifications (6) serum creatinine levels (>1.28 mg dL(-1) vs. <1.28 mg dL(-1)), (7) GFR, (8) wound infection and (9) wound defect size. RESULTS: Of the 33 patients, 15 showed complete healing and 18 showed complications of the free flap (eight partial necrosis and 10 flap failure). No atherosclerotic calcifications were found in the patients in the complete healing group, although they were found in 12 patients in the complication group, and this difference was significant (p = 0.002). Patients with serum creatinine levels >1.28 mg dL(-1) had significantly higher free flap transfer complication rates than those with serum creatinine levels <1.28 mg dL(-1) (p = 0.038). CONCLUSIONS: This study analysed the risk factors of free flap reconstruction for limb-threatening large soft tissue defects on the feet of type 2 diabetic patients. Serum creatinine levels >1.28 mg dL(-1) and atherosclerotic calcifications were confirmed as risk factors for flap survival.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Pé Diabético/cirurgia , Pé/patologia , Retalhos de Tecido Biológico/efeitos adversos , Retalho Miocutâneo/efeitos adversos , Idoso , Calcinose/complicações , Creatinina/sangue , Pé Diabético/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/cirurgia , Doenças Vasculares Periféricas/complicações , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento
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