Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
J Trauma Acute Care Surg. 2012 Mar;72(3):744-50. doi: 10.1097/TA.0b013e31822a2f2b.
Partial necrosis is a main complication of reverse sural artery flap. The purpose of this article is to evaluate effect of flap factors on partial necrosis in the flap.
We retrospectively reviewed data of 175 patients with 179 flaps used to reconstruct soft tissue defects in the distal lower leg, heel, and foot between April 2001 and April 2010. Posterior aspect of the lower leg was equally divided into nine zones. The flap factors were compared between the survival flaps and the partial-necrosis flaps.
There were 141 flaps surviving completely; distal de-epithelialization and wound dehiscence developed in 12 flaps and 6 flaps, respectively; partial necrosis occurred in 20 (11.2%) flaps. Partial-necrosis rate was significantly higher in the flaps with top-edge locating in the upper 1/9 of the calf (32.3%, 10 of 31), in the flaps with length-width ratio (LWR) ≥5:1 (17.8%, 13 of 73), or in the flaps with width of skin island (width) ≥8 cm (15.2%, 16 of 105); it was significantly lower in the flaps with top-edge locating in the lower 7/9 of the calf (3.8%, 3 of 80). Seventeen (80.9%) of 21 flaps with LWR ≥6:1 survived, and the maximal LWR of completely survival flap was 7.00:1.
Probability of partial necrosis occurring in reverse sural artery flap significantly increase when top-edge of the flap locates in the upper 1/9 of the calf, when LWR of the flap is 5:1 or more, or when width is 8 cm or more. The flap with top-edge locating lower 7/9 of the calf is safe and reliable.
部分坏死是逆行腓肠动脉皮瓣的主要并发症。本文旨在评估皮瓣因素对皮瓣部分坏死的影响。
我们回顾性分析了 2001 年 4 月至 2010 年 4 月期间 175 例患者 179 个皮瓣用于修复小腿远端、足跟和足部软组织缺损的资料。小腿后面等分为 9 区。比较存活皮瓣和部分坏死皮瓣的皮瓣因素。
141 个皮瓣完全存活；12 个皮瓣出现远端去表皮化，6 个皮瓣出现切口裂开；20 个（11.2%）皮瓣发生部分坏死。皮瓣顶端位于小腿上 1/9（32.3%，31 个中的 10 个）、长宽比（LWR）≥5：1（17.8%，73 个中的 13 个）或皮岛宽度（width）≥8cm（15.2%，105 个中的 16 个）的皮瓣部分坏死发生率较高；皮瓣顶端位于小腿下 7/9（3.8%，80 个中的 3 个）的皮瓣部分坏死发生率较低。17 个（80.9%）LWR≥6：1 的皮瓣存活，完全存活皮瓣的最大 LWR 为 7.00：1。
皮瓣顶端位于小腿上 1/9、LWR 为 5：1 或以上、宽度为 8cm 或以上时，逆行腓肠动脉皮瓣发生部分坏死的可能性显著增加。皮瓣顶端位于小腿下 7/9 的皮瓣安全可靠。
