Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 17;24(1):963.
doi: 10.1186/s12903-024-04712-w.

Multi-factor early monitoring method based on D-dimer for iliac crest flap loss

Zhou-Yang Wu #  1 , Ying Zhou #  2 , Si-Rui Ma  1   2 , Zi-Li Yu  3   4 , Jun Jia  5   6
Affiliations

Multi-factor early monitoring method based on D-dimer for iliac crest flap loss

Zhou-Yang Wu et al. BMC Oral Health. .

Abstract

Background: In recent years, the utilization of autogenous vascularized iliac crest flap for repairing jaw defects has seen a significant rise. However, the visual monitoring of iliac bone flaps present challenges, frequently leading to delayed detection of flap loss. Consequently, there's a urgent need to develop effective indicators for monitoring postoperative complications in iliac crest flaps.

Methods: A retrospective analysis was conducted on 160 patients who underwent vascularized iliac crest flap transplantation for jawbone reconstruction from January 2020 to December 2022. We investigated the changes in D-dimer levels among patients with or without postoperative complications. Additionally, multivariable logistic regression analysis was performed to explore potential individual risk factors, including surgical duration, age, pathology type, absolute and relative D-dimer levels, and gender, culminating in the development of a nomogram.

Results: On the first day following surgery, patients who experienced thrombosis exhibited a substantial increase in plasma D-dimer levels, reaching 3.75 mg/L, 13.84 times higher than the baseline. This difference was statistically significant (P < 0.05) compared to patients without postoperative complications. Furthermore, the nomogram we have developed and validated effectively predicts venous thrombosis, assigning individual risk scores to patients. This predictive tool was assessed in both training and validation cohorts, achieving areas under the curve (AUC) of 0.630 and 0.600, with the 95% confidence intervals of 0.452-0.807 and 0.243-0.957, respectively.

Conclusions: Our study illustrates that postoperative plasma D-dimer levels can serve as a sensitive biomarker for monitoring thrombosis-induced flap loss. Moreover, we have developed a novel prediction model that integrates multiple factors, thereby enhancing the accuracy of early identification of patients at risk of thrombosis-associated flap loss. This advancement contributes to improving the overall management and outcomes of such procedures.

Keywords: Bone transplantation; D-dimer; Flap loss; Iliac crest flap; Jaw reconstruction; Monitoring method.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow diagram illustrating the case search and selection criteria
Fig. 2
Fig. 2
Multidimensional analysis of preoperative D-dimer levels. Maxillary surgery (A) and mandibular surgery (B). The baseline levels are categorized by age (C), gender (D), presence or absence of systemic disease (E) and pathological types (F)
Fig. 3
Fig. 3
Post-op D-dimer level changes in uncomplicated patients. Post-op D-dimer levels (A) in SCC or ameloblastoma patients (B), variations on the first post-op day (C-H), and correlation with age (I, J) and operation time (K, L)
Fig. 4
Fig. 4
D-dimer analysis in normal, flap loss and titanium plate rejection patients. (A) Imaging and clinical manifestations, (B) baseline D-dimer, (C) age distribution, (D, F) absolute and relative post-op D-dimer, (E, G) absolute and relative day-one post-op D-dimer
Fig. 5
Fig. 5
Multifactor prediction model for post-op D-dimer levels. (A) Multivariate regression analysis of risk factors affecting post-op D-dimer levels, (B) integrated risk factors for prediction, (C) ROC curves for D-dimer prediction in training and validation sets
See this image and copyright information in PMC

References

    1. Brown JS, Barry C, Ho M, Shaw R. A new classification for mandibular defects after oncological resection. Lancet Oncol. 2016;17(1):e23–30. 10.1016/S1470-2045(15)00310-1 - DOI - PubMed
    1. Han J, Guo Z, Wang Z, Zhou Z, Liu Y, Liu J. Comparison of the complications of mandibular reconstruction using fibula versus iliac crest flaps: an updated systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2022;51(9):1149–56. 10.1016/j.ijom.2022.01.004 - DOI - PubMed
    1. Shan X, Cai Z. Dental implant treatment in vascularized bone flaps after jaw reconstruction. Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi Kouqiang Yixue Zazhi = West. China J Stomatology. 2023;41(2):123–8. - PMC - PubMed
    1. Wu L, Wang X, Liu K, Shang Z, Wu T, Shao Z. Vascular iliac myofascial flap to repair compound defect of the jaw. J Stomatology oral Maxillofacial Surg. 2022;123(6):666–71.10.1016/j.jormas.2022.06.022 - DOI - PubMed
    1. Mashrah MA, Aldhohrah T, Abdelrehem A, Sakran KA, Ahmad H, Mahran H, Abu-Lohom F, Su H, Fang Y, Wang L. Survival of vascularized osseous flaps in mandibular reconstruction: a network meta-analysis. PLoS ONE. 2021;16(10):e0257457. 10.1371/journal.pone.0257457 - DOI - PMC - PubMed

Substances

LinkOut - more resources