逆行带蒂腓肠筋膜皮瓣的部分坏死相关因素分析△

Factors related to partial necrosis of reverse sural fasciocutaneous flap for tissue defect of distal end of the lower extremity

摘要:

［目的］ 总结 435 肢逆行带蒂腓肠筋膜皮瓣修复下肢远端组织缺损的临床经验，分析皮瓣发生部分坏死的危险因素。［方法］ 2001 年 4 月—2019 年 12 月，应用逆行带蒂腓肠筋膜皮瓣修复下肢远端皮肤软组织缺损 435 肢。采用单项因素比较与二元多因素逻辑回归分析皮瓣坏死的危险因素。［结果］ 435 肢中，部分坏死 39 例，占 8.97%；完全成活 396 例，占 91.03%。单项因素比较表明，两组在性别构成、年龄、皮肤软组织的缺损部位的差异无统计学意义 （P>0.05）。部分坏死组皮瓣筋膜蒂的长度和宽度、皮岛的宽和旋转点位置均大于成活组，但差异无统计学意义 （P>0.05）；部分坏死组在皮岛的长度、 皮瓣总长、皮瓣长宽比和皮瓣近端位置区划值均显著大于成活组 （P<0.05）。逻辑回归分析显示：皮瓣的总长度大 （OR= 3.462，P=0.015） 和皮瓣近端位置区划值高 （OR=3.817，P<0.001） 是皮瓣发生部分坏死的独立危险因素。［结论］ 逆行带蒂腓肠筋膜皮瓣的部分坏死主要与皮瓣设计不良有关，其中，皮瓣的总长度大、皮瓣近端位置过靠近侧是部分坏死的主要危险因素。

Abstract:

[Objective] To summarize the clinical experience of reverse sural fasciocutaneous flap for tissue defect of distal end of the lower extremity in 435 limbs, and explore the risk factors of partial necrosis of the flap. [Methods] From April 2001 to December 2019, skin and soft tissue defects in distal ends of 435 legs were repaired with reverse sural fasciocutaneous flap in our hospital. Univariate com- parison and binary multiple logistic regression analysis were conducted to search the factors related to partial necrosis of the flap. [Results] Among 435 limbs, partial necrosis of the flap occurred in 39 limbs, accounted for 8.97%, while completely survival flap was seen in 396 limbs, accounted for 91.03%. In term of univariate comparison, there were no significant differences in gender composition, age and defect site of skin and soft tissue between the two groups (P＞0.05) . The partial necrosis group had greater length and width of fascia pedicle, as well as greater width of skin island and position of rotation point than the survival group, but which were not statistically significant (P＞ 0.05) . However, the partial necrosis group had significantly greater length of skin island, the total length of skin flap, the ratio of length to width of flap and extent of proximal location of the flap than the survival group (P＜0.05) . As results of logistic regression analysis, the lon- ger total length of the flap (OR=3.462, P=0.015) , and greater extent of proximal location of the flap were independent risk factors for partial necrosis of the flap. [Conclusion] The partial necrosis of reverse sural fasciocutaneous flap is mainly related to poor design of the flap, among which, the greater overall length and proximal position of the flap are the main risk factors related to partial necrosis.