Factors Associated with Vascular Crisis after Free Latissimus Dorsi Myocutaneous Flap Reconstruction for Head and facial Cutaneous Malignancies:a Retrospective Cohort Study
WANG Fei
Abstract：Objective To analyze factors associated with vascular crisis(VC)following free latissimus dorsi myocutaneous flap reconstruction for head and facial cutaneous malignant tumors.Methods This retrospective study included 116 patients who underwent free latissimus dorsi myocutaneous flap reconstruction for head and facial cutaneous malignancies at Changzhi People's Hospital between May 2022 and October 2023.Patients were grouped by postoperative occurrence of VC:VC group(n=43)and non-VC(N-VC)group(n=73).The timing of VC and salvage outcomes were recorded.The coagulation parameters,hemorheological parameters,and hemodynamic parameters,repair scores and repair efficacy were compared between groups.Independent risk factors for VC were identified using multivariable logistic regression to construct a prediction model.Discrimination and calibration were assessed using receiver operating characteristic(ROC)curve and calibration curve,with internal validation by enhanced bootstrap resampling.Variable importance within the model was ranked.The predictive efficacy of the model was appraised by employing calibration curves to examine its accuracy.The model underwent internal validation utilizing an enhanced bootstrap sampling method,and the importance of the predictor variables was ranked.Results Of the 43 patients who experienced VC,salvage was most successful when VC occurred within 24 hours after surgery(65.38%,17/26)and least successful when it occurred beyond 72 hours(0/3).Overall,the VC salvage success rate was 53.49%(23/43).Coagulation indices and hemodynamic parameters did not differ significantly between the VC and N-VC groups at any time point(all P>0.05).By postoperative day 3,high-and low-shear whole blood viscosity,plasma viscosity,and the erythrocyte aggregation index had significantly decreased relative to preoperative,intraoperative,and postoperative day 1 values in both groups(all P<0.05),and each measure was significantly lower in the N-VC group than in the VC group(all P<0.05).At 6 months after reconstruction,flap color,facial aesthetic appearance,and functional status scores improved significantly versus each group's pre-reconstruction baseline(all P<0.05),with greater improvements in the N-VC group than in the VC group(all P<0.05).The clinical effectiveness rate was significantly higher in the N-VC group than in the VC group(93.15%vs 74.42%;P<0.05).In multivariable logistic regression,smoking history,end-to-side venous anastomosis,excessive intraoperative blood loss,and prolonged operative time independently increased the risk of postoperative VC after free latissimus dorsi flap reconstruction(all P<0.05).Model diagnostics showed no meaningful multicollinearity and good performance in discrimination,predictive accuracy,and internal validation.Predictor importance(descending)was:end-to-side venous anastomosis(0.171),excessive intraoperative blood loss(0.158),smoking history(0.147),and operative time(0.133).Conclusion Venous endtoside anastomosis,excessive intraoperative blood loss,smoking history,and prolonged operative duration are independent risk factors for VC after free latissimus dorsi myocutaneous flap reconstruction for head and facial cutaneous malignancies.
Keywords：tumorshead and facefree tissue flapslatissimus dorsi musclereconstructive surgeryvascular crisisrisk factors
Publication Date：2025-12-10
Online Publishing Date：2026-01-04(First online date of this platform, not the publication date of the document)
Pages：8( 444-451 )