Role of Thrombolysis in Free-Flap Salvage
Pourquoi ce travail est dans la base
Une base qui oublie comment elle a trouvé un travail ne peut pas être vérifiée. Voici les voies qui ont admis celui-ci.
Notice bibliographique
Résumé
Approximately 5 percent of microvascular free-tissue transfers fail; often this is due to microvascular or peri-anastomotic thrombosis. Various reports have advocated the use of thrombolytics for salvage of these flaps, although clinical evidence supporting this approach is sparse. The authors attempted to review their own and other published results and present an algorithm for the use of thrombolytics in the management of failing free flaps. A retrospective review of 590 free flaps, revealed 71 (12 percent) requiring re-exploration for impending flap failure, determined by standard clinical indicators. Forty-four (62 percent) were found to have pedicle thrombosis and 20 (28 percent) received thrombolysis with streptokinase or urokinase. All 44 flaps were grouped by final outcome and thrombolytic use for comparison. In 24 (55 percent) of the flaps with evidence of thrombosis, the use of thrombolytics was felt to be inappropriate or unnecessary; 13 (54 percent) of these were salvaged. Twenty flaps, however, did receive thrombolysis and 6 (30 percent) of these were salvaged. There was no statistically significant difference among groups with respect to preoperative risk factors, age, gender, flap type, and site of anastomotic thrombosis. There was a twofold higher use of vein grafts in the failed vs. salvaged flaps (36 percent vs. 15.7 percent), and no flaps with vessel grafts were salvaged with thrombolytics. Despite the fact that all flaps were re-explored within 3 hr of a problem being detected, the mean time from the initial operation to re-exploration was significantly higher in flaps that did not respond to thrombolytics (63. 8 vs. 32.8 hr, respectively, p=0.0457). Also, the mean time to re-exploration was significantly higher in the salvaged flaps receiving thrombolysis vs. those that did not (32.8 vs. 22.3 hr, respectively, p=0.0264). While early detection and re-exploration are crucial for salvaging failing free flaps, those flaps unresponsive to other standard interventions may benefit from the selective use of thrombolytics.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle