皮神经营养血管皮瓣术后色素沉着的相关因素△

Factors related to postoperative pigmentation of cutaneous neurotrophic vascular flaps

摘要:

[目的] 探讨以皮神经营养血管皮瓣修复四肢软组织缺损术后皮瓣发生色素沉着的相关因素。[方法] 回顾性分析 2013 年 1 月—2022 年 2 月于本院急诊行皮神经营养血管皮瓣治疗的 185 例患者临床资料，按照皮瓣术后是否发生色素沉着分为色素沉着组和非色素沉着组，采用单因素分析与多因素逻辑回归分析皮瓣是否发生色素沉着的影响因素。[结果]185 例中， 色素沉着 36 例，占比 19.5%；非色素沉着 149 例，占比 80.5%。单项因素分析表明，色素沉着组吸烟 [是/否, (24/12) vs (67/82), P= 0.019]、糖尿病 [是/否, (15/21) vs (25/124), P=0.010]、高血压病 [是/否, (18/18) vs (28/121), P＜0.001]、早期血管危象 [是/否, (14/22) vs (5/144), P＜0.001] 的比率显著高于无色素沉着组，但是，前者的行血管吻合 [是/否, (4/32) vs (75/74), P＜0.001] 和皮瓣早期存活 [是/ 否, (24/12) vs (145/4), P＜0.001] 的比率显著低于无色沉着组。此外，前者损伤至手术时间显著长于后者 [(8.5±2.4) h vs (7.1±3.1) h, P= 0.019]。逻辑回归分析显示：早期血管危象（OR=20.228, P=0.042）、高血压（OR=7.727, P＜0.001）、吸烟（OR=4.129, P=0.010）、 糖尿病（OR=4.121, P=0.012）是皮瓣发生色素沉着的独立危险因素，血管吻合（OR=0.080, P=0.001）是保护因素。[结论] 患者自身吸烟，患高血压病、糖尿病及术后早期发生血管危象者更易发生皮瓣色素沉着，而血管吻合可以减少色素沉着的发生率。

Abstract:

[Objective] To investigate the factors related to pigmentation of cutaneous neurotrophic vascular flap for repair of soft tissue defect. [Methods] A retrospective study was conducted on 185 patients who received cutaneous neurotrophic vascular flap in emergency for repair of soft tissue defect in our hospital from January 2013 to February 2022. They were divided into pigmentation group and non-pigmentation group according to whether pigmentation occurred 3 months after the skin flap operation. Univariate comparison and multivariate logistic regression were used to analyze the factors related to the pigmentation. [Results] Among the 185 patients, 36 patients were confirmed as pigmented, accounting for 19.5%; while the raining 149 cases were non-pigmented, accounting for 80.5%. As result of univariate comparison, the pigmented group proved significantly higher ratio than the non-pigmented group in terms of smoking [Y/N, (24/12) vs (67/82), P= 0.019], diabetes [Y/N, (15/21) vs (25/124), P=0.010], hypertension [Y/N, (18/18) vs (28/121), P＜0.001], early vascular crisis [Y/N, (14/22) vs (5/144), P＜0.001], and the former had significantly greater time interval between injury and operation [(8.5±2.4) h vs (7.1±3.1) h, P=0.019]. However, the pigmented group was significantly lower than the non-pigmented group in ratios of vascular anastomosis [Y/N, (4/32) vs (75/ 74), P＜0.001] and early flap survival [Y/N, (24/12) vs (145/4), P＜0.001]. Regarding to logistic regression analysis, the early vascular crisis (OR=20.228, P=0.042), hypertension (OR=7.727, P＜0.001), smoking (OR=4.129, P=0.010), diabetes (OR=4.121, P=0.012) were independent risk factors for skin flap pigmentation, while vascular anastomosis (OR=0.080, P=0.001) was of protective factors. [Conclusion] Skin flap pigmentation is more likely to occur in patients with smoking, hypertension, diabetes and early postoperative vascular crisis, while vascular anastomosis can reduce the occurrence of pigmentation.