Perfusión del colgajo libre en la reconstrucción microvascular de cabeza y cuello: influencia del número de intervalos de isquemia y de la duración de la isquemia – un estudio retrospectivo

BACKGROUND: In microvascular head and neck reconstruction, ischemia of the free flap tissue is inevitable during microsurgical anastomosis and may affect microvascular free flap perfusion, which is a prerequisite for flap viability and a parameter commonly used for flap monitoring. The aim of this study was to investigate the influence of the number of ischemia intervals and ischemia duration on flap perfusion. METHODS: Intraoperative and postoperative flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation at 2 and 8 mm tissue depths, as measured with the O2C tissue oxygen analysis system, were retrospectively analyzed for 330 patients who underwent microvascular head and neck reconstruction between 2011 and 2020. Perfusion values were compared between patients without (control patients) and with a second ischemia interval (early or late) and examined with regard to ischemia duration. RESULTS: Intraoperative and postoperative flap blood flow at 8 mm tissue depth were lower in patients with early second ischemia intervals than in control patients [102.0 arbitrary units (AU) vs 122.0 AU, P = .030; 107.0 AU vs 128.0 AU, P = .023]. Both differences persisted in multivariable analysis. Intraoperative and postoperative flap blood flow at 8 mm tissue depth correlated weakly negatively with ischemia duration in control patients (r = -.145, P = .020; r = -.124, P = .048). Both associations did not persist in multivariable analysis. CONCLUSIONS: The observed decrease in microvascular flap blood flow after early second ischemia intervals may reflect ischemia-related vascular flap tissue damage and should be considered as a confounding variable in flap perfusion monitoring.

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Se analizaron retrospectivamente con el sistema O2C los valores de perfusión de 330 pacientes con reconstrucción microvascular de cabeza y cuello (2011–2020). Los pacientes con un segundo intervalo de isquemia precoz mostraron menor flujo a 8 mm de profundidad que los controles (102,0 vs. 122,0 UA, p = 0,030; 107,0 vs. 128,0 UA, p = 0,023); ambas diferencias persistieron en el análisis multivariable. Según los autores, este descenso podría reflejar daño vascular isquémico y debe considerarse variable de confusión.

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