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Abstract：
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.
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.
摘要：
背景：在微血管头颈部重建中，游离皮瓣组织的缺血在显微外科吻合术中是不可避免的，并可能影响微血管游离皮瓣的灌注，这是皮瓣生存能力的先决条件，也是皮瓣监测常用的参数。本研究的目的是研究缺血间隔数和缺血持续时间对皮瓣灌注的影响。
方法：术中和术后皮瓣血流量，血红蛋白浓度,组织深度为2和8毫米的血红蛋白氧饱和度，用O2C组织氧分析系统测量，对2011年至2020年间接受微血管头颈部重建的330例患者进行了回顾性分析。在没有（对照患者）和第二次缺血间隔（早期或晚期）的患者之间比较了灌注值，并检查了缺血持续时间。
结果：早期第二次缺血间隔患者的术中和术后组织深度为8mm的皮瓣血流量低于对照组患者[102.0任意单位（AU）vs122.0AU，P=.030；107.0AU与128.0AU，P=.023]。两种差异在多变量分析中仍然存在。对照组患者术中和术后8mm组织深度的皮瓣血流量与缺血持续时间呈弱负相关（r=-.145，P=.020；r=-.124，P=.048）。在多变量分析中，这两种关联都不存在。
结论：在早期第二次缺血间隔后观察到的微血管皮瓣血流量减少可能反映了缺血相关的血管皮瓣组织损伤，应被视为皮瓣灌注监测中的混杂变量。
方法：术中和术后皮瓣血流量，血红蛋白浓度,组织深度为2和8毫米的血红蛋白氧饱和度，用O2C组织氧分析系统测量，对2011年至2020年间接受微血管头颈部重建的330例患者进行了回顾性分析。在没有（对照患者）和第二次缺血间隔（早期或晚期）的患者之间比较了灌注值，并检查了缺血持续时间。
结果：早期第二次缺血间隔患者的术中和术后组织深度为8mm的皮瓣血流量低于对照组患者[102.0任意单位（AU）vs122.0AU，P=.030；107.0AU与128.0AU，P=.023]。两种差异在多变量分析中仍然存在。对照组患者术中和术后8mm组织深度的皮瓣血流量与缺血持续时间呈弱负相关（r=-.145，P=.020；r=-.124，P=.048）。在多变量分析中，这两种关联都不存在。
结论：在早期第二次缺血间隔后观察到的微血管皮瓣血流量减少可能反映了缺血相关的血管皮瓣组织损伤，应被视为皮瓣灌注监测中的混杂变量。
