| Objective:was summarized to experience of the maxillofacial surgical team in our hospital in recent years and the influencing factor of the operation time of free tissue flap and vascular crisis were analyzed,so as to provide reference for the maxillofacial surgical team in our hospital to shorten the operation time and reduce the occurrence of vascular crisis in the future,and to improve the survival rate of skin flap.Methods:.Clinical data of patients with maxillofacial acquired tissue defects repaired by vascularized free skin flap in orthognathic surgery and oral and maxillofacial oncology department of the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2019 were retrospectively analyzed.According to the inclusion and exclusion criteria,clinical data of 155 patients were included.Through the electronic medical record database statistical analysis of the patient’s gender,age,body mass index(BMI),blood pressure,diabetes,history,head and neck surgery,radiation and chemotherapy history,history of alcohol,tobacco,clinical stage,tissue defect causes,malignant tumor,and the size of the defect parts and flap,the types of tissue flap,the blood vessels,vascular anastomosis,number of venous anastomosis,length of hospital stay,operation time,whether has occurred Vascular crisis and other complications.Excel was used to establish database,and SPSS23.0 statistical software was used to conduct chi-square test for single factor variables.Multivariate analysis was performed using Logistic regression to analyze the factors affecting the operation time and the risk factors of vascular crisis.RESULT:Of the 155 cases,159 flaps were prepared.Among the causes of defect,26 cases were benign tumors,accounting for 16.8%.124 cases of malignant tumor,accounting for 80%;5 cases of inflammation,accounting for 3.2%.The radial forearm flap was prepared in 85 cases,accounting for 53.5%.40 cases(25.2%)of tongue defects were repaired in different parts.109 anastomotic arteries(68.6%)were found in the recipient area.There were 94 total facial veins,accounting for 42.5%.End-to-end vascular anastomosis was commonly used in 148 cases(93.1%).The single vein anastomosis was the most common in 108 cases(67.9%).The operation time was 195-1010min,with an average of 528min.There were 137 cases(86.2%)without vascular crisis during the operation.Vascular crisis occurred in 22 cases(13.8%).Among them,14 cases(63.6%)of skin flaps were successfully saved through surgical exploration,141 cases survived completely(88.7%).In 10 cases,partial necrosis occurred,accounting for 6.3%.5 cases(3.1%)had long-term dressing change after skin flap necrosis.In 3 cases,the flap was replaced by another operation after necrosis,accounting for 1.9%.The necrosis of the skin flap was completely removed in 1 case,and the free skin flap was repaired again 2 years later.The infection occurred in 49 cases(30.8%).Univariate analysis showed that there was no statistical significance between preoperative radiotherapy,benign and malignant tumors,type of skin flap and number of venous anastomosis and operation time(P>0.05).BMI<18.5(P=0.03),diabetes mellitus(P=0.02)and vascular crisis after vascularized free skin flap were statistically significant.Logistics regression analysis showed that BMI<18.5(P--0.03,OR=1.4)and diabetes(P=0.03,OR=1.36)were risk factors for the occurrence of vascular crisis.Conclusion:Among the numerous influencing factors in this study,benign and malignant tumors,type of skin flap and number of venous anastomosis may not be risk factors affecting the operation time.BMI<18.5,diabetes may be a risk factor for vascular crisis of free tissue flap,but it is not clear whether other factors can lead to prolonged operation time and cause vascular crisis.Due to many preoperative and postoperative confounding factors,small sample size and other reasons,the study results may be affected. |
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