Clinical Investigation Of Vascular Compromise In Free Anterolateral Thigh Flaps

Objective:To analyze the causes of vascular compromise as well as the factors that influence its successful salvage in free anterolateral thigh flaps, and discuss the possibilities and methods of further increasing the success rate of flap transfer.Methods:We reviewed722cases of free anterolateral thigh flaps transferred for oral-facial reconstruction performed by department of oral and maxillofacial surgery in Second Xiangya Hospital of Central South University between January2007and April2012, and analyze the characteristics and causes of25cases of vascular compromise as well as the factors that influence their successful salvage.Results:(1)722cases of free anterolateral thigh flap with15cases of them developing necrosis has a transfer success rate of97.78%. Among a total of722cases, the flaps in25cases occurred vascular compromise postoperatively, with a percentage of3.46%. In the25compromised flaps, there are10flaps were salvaged, including8ones completely salvaged and2ones partially salvaged, and the salvage rate was40%.(2)There are20cases of venous compromise among25cases of vascular compromise, with a percentage of80%.And the others are arterial compromise, with a percentage of20%. The vascular compromise was detected between postoperative2hours and15minutes and the18th day postoperatively.19cases of vascular compromise were detected within postoperative72h, with a percentage of76%, and6cases of it were detected after postoperative72h, with a percentage of24%.11cased out of25cases of vascular compromise were detected within postoperative24h, and8cases were salvaged successfully, with a success rate of72.72%. There are14cases of vascular compromise detected after postoperative24h, and of which2flaps were salvaged successfully, with a success rate of13.57%(P=0.005).10cases of vascular compromise underwent flap explorations within2.5h on the presenting time of it, and8cases were salvaged successfully, with a success rate of80%. And8cases of vascular compromise underwent flap explorations between2.5h-5.0h on the presenting time of it, only one salvaged successfully, with a success rate of12.50%(P=0.010).(3) In a total of25cases of vascular compromise,12cases were caused by the compression, stretching, negative pressure and twisting of vessels,2cases were due to thrombosis in vascular anastomostic,3cases were caused by injured perforators and2cases were due to flap thinning.(4) There are10cases of venous compromise salvaged successfully, with a success rate of50%. While, arterial compromise were all failed to survive.8cases out of9cases of venous compromise caused by stretching and compression of vessels were successfully salvaged, with a success rate of88.89%. There were15compromised flaps with2perforators and9with1perforator, with a salvage success rate of60%and11.11%, respectively((P=0.018).(5) Gender, age, hypertension, diabetes mellitus and hyperlipemia have no significant difference in the incidence of vascular compromise and salvage success rate of flaps.Conclusion:1.The majority of flap vascular compromise is venous compromise, which has a high salvage success rate within postoperative24h.2.Early detection and urgent flap exploration is the best effective measure to salvage compromised flaps. And vascular compromise has a high salvage success rate within2.5h on the presenting time of it.3.Reduce the external forces on vascular pedicles and perforators by compression, stretch, negative pressure and so on, which is important to prevent flap vascular compromise4.Flaps with2perforators has a higher salvage success rate than flaps with1perforator. When a large flap is harvested, more perforators should be considered in designing it.5.Gender, age, hypertension, diabetes mellitus and hyperlipemia have no significant difference in the incidence of vascular compromise and salvage success rate of flaps.