The Analysis For The Reason Of Postoperative Complications Of Free Tissue Flaps Which Were Used To Repair The Vacancy Of Head And Neck Tumors

Objective：To study the reason of Postoperative complications of free tissueflaps,in order to improve the success-rate of the surgery.Methods：Surgery methods: free tissue flap and lesion resection is divided into twogroups at the same time. Two groups closely cooperate, when complete resection isfully ready for tissue flap from the primary lesion and leave off the vessel pedicle of thedonor tissue flap, so that we can maximum reduce tissue flap ischemia time, improvethe survival rate of tissue flap arteriovenous of preparation with the district do end toend anastomosis arteriovenous, consistent with soft and delicate, reduce vascularendothelial damage as far as possible; Research methods: The clinical data of63patients who were used free tissue flaps to repair the postoperative vacancy of head andneck tumors were retrospectively analyzed，Tongue cancer17cases,9cases of buccalmucosa cancer, stomach cancer, tonsil carcinoma in11cases,14cases were carcinomain9cases, oropharyngeal carcinoma (3cases). According to the2002internationalcancer alliance (UICC) standard, patients are in middle-late stage.Results：There were11cases presented vascular crisis after the surgery, the rateof vascular crisis is17.46%.Of all the11cases,9cases were vein crisis and2caseswere artery crisis. At last，4cases presented flap necrosis, the rate of necrosis is6.35%.All are anterolateral thigh flap necrosis (1case was partial necrosis,3cases areall).Pre-operative factors which are related to postoperative complications including:age, hypertension, highly-condensed condition，long history of smoking and properlydrinking; The factors during the surgery contain the base of the vascular is too long andthe group of vasculars which are used to link; Postoperative factors contain drainageafter the surgery and hormonetherapy. Aged more than60years with diabetes, highcoagulation state and long history of smoking in patients with vascular crisis lead to higher rates of tissue flap necrosis, patients with history of long-term drinking amoderate amount of tissue flap necrosis rate is lower than nondrinkers, statisticalresults show that all showed obvious differences; The pedicle is anastomosed surplusmore than2cm, a group of arteriovenous flap necrosis rate is significantly higher than inpatients with vascular pedicle surplus within2cm, two groups of patients with venousanastomosis group artery; Adequate drainage and postoperative application ofdexamethasone and other hormonal drugs patients tissue flap necrosis rate is low, thestatistical results have obvious differenceConclusion: Part there, no matter what kind of free tissue flap necrosis risk,choose reasonable operation time, fully grasp the status of the patients is to ensure thatlarge areas of free flap transplantation survival foundation and the premise. Older, withhigh coagulation state, history of diabetes, and long-term smoking history for high riskfactors of postoperative blood vessel articulo, if chose surgery indications inpreoperative assessment with the above risk factors when measured or disable surgery,if you have surgery, postoperative should strengthen surveillance, beware of vascularcrisis after cardiac surgery, avoid free tissue flap necrosis, and moderate drinking for along time to avoid postoperative tissue flap necrosis has certain benefits, long vascularpedicle and prone to vascular compression or discount, can lead to tissue flap of poorblood flow and ischemia necrosis, in addition, on the premise of conditions permit,select sets of venous anastomosis, as much as possible is usually at least two groups ofveins, such is far lower than the incidence of vascular crisis only fits a set of veins.Postoperative can preliminary judgment according to advantages of tissue flap, adequatedrainage, found that abnormal timely treatment, appropriate application ofdexamethasone hormone drugs at the same time, to prevent the happening of thevascular crisis, improving the survival rate of tissue flap has positive clinical signific-ance.The impeccable estimate before the surgery of free tissue flaps to reconstruct thevacancy which is left after the head and neck surgery, mastering the indications of theoperation strictly,and consummate management during and after the surgery is crucial toreduce the complications and increase the rate of success of the surgery.