Factors Associated with Free Flap Survival for Patient Receiving Microsurgical Free Flap Transplantation

• Main Authors: Chien-Chang Chen, 陳建璋
• Other Authors: Nai-wen Chang
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/bkf78m

碩士 === 國防醫學院 === 護理研究所 === 106 === Background: At its most basic level, a flap is a portion of tissue that can be dissected, elevated, and inset into a nonanatomic position as a consequence of its vascular supply and outflow. By this definition, flaps may be composed of any combination of skin, fascia, muscle, and bone. Free tissue transfer currently is used for the reconstruction of complex defects and disorders throughout the body to improve the patient's limb function or body appearance. At present, physicians and nurses evaluate the survival of the free flap by subjective report the change of the color which naked-eyes observed that it is not the quantitative data. The discrepancy existed between the physician and the nurse which may delay to manage the perfusion problem of the free flap after the microsurgical free flap transplantation. We hope to find the factors associated with free flap survival for patient receiving microsurgical free flap transplantation, and use the equipment to quantify the data to help clinical staff report consistently and detect the occlusion earlier to improve flap survival. Methods: A single group time-series preexperimental design was applied. A convenience sample of 35 free flap transplantation patients was recruited from a burn center of a northern medical center in Taipei, Taiwan from May 2016 to May 2017. Patients performed tests that included Color Reader (CR-10), Doppler (LifeDop 150 with 4 MHz Probe), and Hard ear thermometer. The post-surgery data was measured every hour for three days, and the seventh day. We analyzed data using Logistic regression of general estimating equations, with p < 0.05 considered significant. Results: The study found a negative correlation between the time and the color change of free flaps. Increasing time risk the free flaps between 18th and 52nd hour, and the flap will be stable after 53rd hour. The b value of Color Reader in free flap was significant (p <0.001). There was a significant correlation (p = 0.006) between the difference of temperature and the changed color of free flap. Conclusion：This study confirmed a significant negative correlation between the time and the stability of the free flap. The Color Reader can provide the objective and quantitative data of color of the free flap for clinical staff to report consistently and detect earlier to improve flap survival.