頭頸部再建における発生時期からみた皮弁うっ血の予防と対処 Prevention and Treatment of Flap Congestion during Head and Neck Reconstruction with Respect to Onset Time
Flap circulation disorder in free tissue transfer surgery is a critical complication as increasingly congestive conditions damage tissue more than ischemia. Flap congestion is caused by several factors and the aim of this study was to identify factors that influenced flap congestion with respect to onset time.<BR>This study analyzed a total of 204 cases of free tissue transplantation in the head and neck region, including 15 congestive cases. All microvascular reconstruction surgeries were performed at the University of Tsukuba Hospital from August 2008 to February 2017. Intra- and postoperative factors that influenced flap congestion were chosen and analyzed based on onset time of congestion.<BR>Within a 24-hour postoperative window, damaged endothelium, excess flap volume, hyper-strained sutures, and swelling of the surgical site were influencing factors. After the 24-hour window, damaged endothelium was the main factor that influenced flap congestion. In addition, we found that failures of the flap arrangement and neck rest, as well as recipient vessel troubles were crucial factors for preventing complications. Using time of onset to categorize flap congestion allows for preventative as well as rapid responses to problems.
日本マイクロサージャリー学会会誌 30(3), 108-115, 2017