Flap Failure in Head and Neck Cancer Patients Who Developed Surgical Site Infection

術後得到手術部位感染的頭頸癌病患發生游離皮瓣壞死

Cristhiam Yang(楊濬安)；Szu-Han Wang(王思翰)；Hsuan-Yu Chou(周宣宇)；Ching-Yu Lan(藍靖宇)；Yao-Chang Liu(劉曜彰)；Huang-Kai Kao(高煌凱)；Chia-Hsuan Tsai(蔡嘉軒)

risk factors ； free flap ； free tissue transfer ； head and neck cancer ； surgical site infection ； flap failure

臺灣整形外科醫學會雜誌

33卷3期（2024 / 09 / 01）

297 - 306

英文;繁體中文

Background: Surgical site infection (SSI) is believed to be correlated with the development of flap failure in head and neck cancer patients. However, not all patients with SSI end up with flap loss. Aim and Objectives: We try to identify the specific factors of development of free tissue failure through this study. Materials and methods: A retrospective review of medical records from September 2018 to August 2020 was performed, to investigate the patients with head and neck cancer who received tumor ablation and immediate free flap reconstruction. Only those patients who had intrahospital SSI were included. Comparison of patient-related and operation-related features between flap loss group and non-flap loss group was processed by using univariate and multivariate logistic regressions for statistical analysis. Results: 21 of 109 patients (19.26%) suffered from the flap loss, with the operation time (adjusted OR 1.58, p = 0.001) being the independent risk factor, and tumor location at tongue as protective factor (adjusted OR 0.08, p = 0.046). Gender, age, tumor characteristics, comorbidities, and different types of osteotomies did not present statistical significance after multivariate analysis. Conclusion: Flap loss was more likely found in SSI patients after prolonged operation. In contrast, tongue cancer patients were less likely to suffered from free flap failure compared to other locations. These findings may serve for reference for the reconstructive surgeons to elaborate the surgical plan and postoperative management.

背景：手術部位感染（SSI）被認為與頭頸部癌症患者的皮瓣壞死有關。然而，并非所有患有SSI的患者最終都會出現皮瓣壞死。目的及目標：通過這項研究，我們試圖找出游離皮瓣壞死的具體因素。材料和方法：我們針對2018年9月至2020年8月的病歷進行了回顧，以調查接受腫瘤切除和立即性游離皮瓣重建的頭頸部癌症患者。僅囊括那些在院內得到手術部位感染的患者。統計分析方面，使用單變量和多變量回歸，針對皮瓣壞死組和沒有皮瓣壞死的兩組之間的患者和手術等相關特徵進行比較。結果：109名手術部位感染的頭頸癌患者中有21名（19.26％）發生皮瓣壞死，手術時間（校正後勝算比1.58，p值=0.001）是獨立風險因素，腫瘤位置發生在舌頭部位則是保護因素（校正後勝算比0.08，p值=0.046）。性別、年齡、腫瘤特徵、合併症和不同類型的截骨在多變量分析後並未發現統計上意義。結論：手術部位感染的頭頸癌患者在手術時間延長後更容易發生皮瓣壞死。相反地，舌癌患者與其他部位相比，較不容易出現游離皮瓣壞死。這些發現可以提供給重建團隊作為制定手術計劃和術後照護方面的參考。