70세 이상의 환자에서 유리 피판술을 이용한 하지 재건의 합병증

Abstract

기대여명이 증가함에 따라, 노인인구에서의 미세수술을 이용한 재건술의 필요가 증가하고 있다. 이 연구의 목적은 유리피판을 이용한 하지재건을 시행한 노인 환자에서 수술결과와 합병증에 대해 알아보는 것이다. 2004년부터 2016년까지 한 대학의 두 개 병원에서 시행한 유리피판을 이용한 하지재건술 증례를 모았다. 후향적 차트 분석을 통하여 분석하였다. 환자를 나이에 따라 A그룹(19-69세)과 B그룹(70세 이상)으로 나누었다. 2개의 그룹 간의 합병증의 차이를 분석하였으며, 합병증은 의학적 합병증과 피판 관련 합병증으로 나누어 연구를 시행하였다. A그룹은 총 258개의 피판술이 포함되었고, B그룹은 49개의 피판술이 포함되었다. 가장 많이 사용된 공여부는 광배근피판이었고, 전외측대퇴피판은 두 번째로 많이 사용되었다. 피판 관련 합병증에서 두 그룹 간의 차이는 없었다. 단변량 분석 및 다변량 분석에서 나이와 심혈관계 질환이 의학적 합병증에 가장 중요한 위험인자로 나타났다. 유리피판을 이용한 하지재건에서 피판 관련 합병증은 나이에 따른 차이가 없지만, 의학적 합병증의 경우는 나이가 많은 사람에서 많이 나타났다. 따라서 나이가 많은 환자에서 유리피판술을 이용한 하지재건을 계획할 때에는 의학적 합병증 발생의 가능성을 고려하여 이러한 결과가 나타나지 않도록 노력을 기울어야 할 것 이다.|With increasing life expectancy, the demand for microsurgical reconstructions is growing steadily. The purpose of this study is to investigate surgical outcomes and the morbidity of older patients receiving free tissue transfer to the lower extremities. Free flap reconstructions of the lower extremities were investigated by a retrospective chart review from 2004 to 2016 at two hospitals of a university medical center. The patients were divided in 2 groups according to their age: Group A (15-69 years) and group B (70 years and more). A comparison of morbidity and complication factors subdivided in medical and flap-related factors was performed between the 2 groups. 258 free flaps were performed in group A, whereas 49 free flaps were operated in group B. Group B had significantly more preexisting diseases than group A. The most frequently used flap was the latissimus dorsi, with anterolateral thigh flap being the second most frequent donor. Neither the overall flap-related complications (21.7% vs. 18.4%, p-value = 0.600), nor singular flap-related complications were significantly different between the two groups (total loss: 1.9% vs. 4.1%, p-value = 0.310; partial flap loss, 10.9% vs. 10.2%, p-value = 0.795; thrombosis: 0.8% vs. 0%, p-value = 1.000; dehiscence: 1.6% vs. 0%, p-value = 1.00; hematoma: 2.3% vs. 0%, p-value = 0.594; bruise: 2.7% vs. 2.0%, p-value = 1.000; and abscess: 1.2% vs. 2.0%, p-value = 0.641, table 3). Univariate and multivariate analysis showed that age and cardiovascular disease were significant predictors of medical complications for group B as compared to group A. The flap-related morbidity of microvascular reconstructions of the lower extremities has similar outcomes in patients older than 70 years. Medical morbidity, however, were more likely to occur in the older age group. Thus, when planning a free flap reconstruction of the lower extremity, in patients older than 70, the increased likelihood of medical morbidity should be considered and every effort should be made to reduce these hazards.; With increasing life expectancy, the demand for microsurgical reconstructions is growing steadily. The purpose of this study is to investigate surgical outcomes and the morbidity of older patients receiving free tissue transfer to the lower extremities. Free flap reconstructions of the lower extremities were investigated by a retrospective chart review from 2004 to 2016 at two hospitals of a university medical center. The patients were divided in 2 groups according to their age: Group A (15-69 years) and group B (70 years and more). A comparison of morbidity and complication factors subdivided in medical and flap-related factors was performed between the 2 groups. 258 free flaps were performed in group A, whereas 49 free flaps were operated in group B. Group B had significantly more preexisting diseases than group A. The most frequently used flap was the latissimus dorsi, with anterolateral thigh flap being the second most frequent donor. Neither the overall flap-related complications (21.7% vs. 18.4%, p-value = 0.600), nor singular flap-related complications were significantly different between the two groups (total loss: 1.9% vs. 4.1%, p-value = 0.310