School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Microsurgery. 2013 Jan;33(1):9-13. doi: 10.1002/micr.21994. Epub 2012 Jun 25.
Early free flap coverage in lower extremity trauma is a practice largely supported by research that may be outdated and is frequently impractical due to logistics, resuscitation efforts, and associated injuries. Our objective was to re-evaluate this paradigm to determine whether reconstructive timing impacts outcome in modern clinical practice. We reviewed 60 free flaps for traumatic lower extremity coverage from December 2005 to December 2010 by the plastic surgery service at an academic medical center. All reconstructions were >72-hours from injury, spanning from 3 days to 2.2 years. The overall failure rate was 13.3% (8/60). Statistical analysis yielded no significant associations between reconstructive timing and flap failure or morbidity, although there was a trend toward fewer failures among latest reconstructions (>91 days) compared to within 30 days (P = 0.053). These findings support that delays may be safely utilized to allow patient and wound optimization without negatively impacting outcomes in free tissue transfer.
早期游离皮瓣覆盖下肢创伤在很大程度上得到了研究的支持，但这些研究可能已经过时，而且由于后勤、复苏努力和相关损伤，实际上往往不切实际。我们的目的是重新评估这一范例，以确定在现代临床实践中重建时机是否会影响结果。我们回顾了 2005 年 12 月至 2010 年 12 月期间由学术医疗中心的整形外科服务进行的 60 例用于外伤性下肢覆盖的游离皮瓣。所有重建均距受伤时间>72 小时，时间跨度为 3 天至 2.2 年。总的失败率为 13.3%（8/60）。尽管存在最新重建（>91 天）比 30 天内重建（P=0.053）失败次数更少的趋势，但统计分析并未显示重建时机与皮瓣失败或发病率之间存在显著关联。这些发现支持这样一种观点，即可以安全地延迟重建以允许患者和伤口优化，而不会对游离组织转移的结果产生负面影响。
