Analysis Of Influencing Factors On Vascular Compromise After Free Tissue Flaps Transplantation

Objective: To summarize the experience of repairing tissue defects after resection of oral maxillofacial-head-neck tumor with free tissue flaps,to analyze the causes of vascular compromise of free tissue flaps post-operation,and to improve the success rate of free tissue flaps for the defects of transplantation.Clinical data and methods: from January 2013 to December 2017,the clinical data of 1880 cases of head and neck defects repaired by free tissue flaps in Hunan Cancer Hospital were retrospectively analyzed.There were analyzed through database,include: Sex,Age,Fat,Blood pressure,Tobacco,Alcohol,D-dimer,Glycosylated hemoglobin,Different flaps,Site of repair,Number of anastomotic veins,History of head and neck radiotherapy,chemotherapy,surgery,Compromise or not,the time between the finish-operation and the occurrence of vascular compromise,the time of surgical exploration after compromise,and other affecting factors of compromise.Univariate analysis were used by chi-square test and t-test,and multivariate analysis was used by multivariate Logistic regression.Of the 1880 patients,1638 were male and 242 were female,with a male-to-female ratio of 6.77.The average age was 50.66 years old.1965 tissue flaps were prepared,the most common soft tissue flap was free anterolateral femoral flap,the ratio is 94.56%(1741/1965)and the most common bone tissue flap was free fibular flap,the ratio is 95.96%(119/125).Results: there were 105 free tissue flaps compromise in this group,the incidence of compromise was 5.34%(105/1965),of which 37 cases were successfully rescued by surgical,and the successful rate of rescue was35.24%.68 cases of necrosis,the overall survival rate was 96.54%.There were 71(67.62%)cases of venous embolism,33 cases of rescue,the success rate of rescue is 46.48%.17(16.19%)cases of arterial embolism,4 cases of rescue,the success rate of rescue is 23.53%.17(16.19%)cases of arterial and venous embolization,all of which were unsuccessful.Univariate analysis showed that Obesity(BMI ? 28kg/m^2),Tobacco,High D-dimer,High glycosylated hemoglobin,History of head and neck radiotherapy and operation,Repair of the floor of oral and number of anastomotic veins were the risk factors of tissue valve compromise.The success rate of flap rescue was decreased in patients over 60 years old.Multivariate analysis showed that obesity,High D-dimer,Floor of oral repair,Number of anastomotic veins were independent risk factors for survival of tissue valves.The time of vascular crisis was from Minute 40 to Day 9 after operation,and 69 cases of tissue valve compromiseoccurred within 24 hours after operation.The success rate of salvage was47.83%(33/69).36 cases of tissue valve vascular compromise occurred more than 24 hours after operation,the success rate of rescue was 11.11%(4/36).It was found that the time from vascular compromise to surgical exploration and rescue of the flap ranged from Hour 0.6 to Hour 36.The successful rate of rescue was 55.0% for patients less than 6 hours and8.89% for those who were more than 6 hours,More than 18 hours of tissue flaps are all necrosis.Conclusion:(1)The incidence of free tissue flap vein compromise and the success rate of rescue were higher than those of arterial compromise.(2)the number of anastomosed veins,obesity,the increase of D-dimer,and the repair the oral floor of free flap were the risk factors of vascular compromise.(3)Vascular compromise was found within 24 hours after operation,and the waiting time for exploration within 6 hours have a higher success rate of rescue.