Cho Eugenia H, Garcia Ryan M, Pien Irene, Kuchibhatla Maragatha, Levinson Howard, Erdmann Detlev, Levin L Scott, Hollenbeck Scott T
Division of Plastic and Reconstructive Surgery, Duke University Health System, Durham, NC.
Department of Biostatistics and Bioinformatics, Duke University Health System, Durham, NC.
Microsurgery. 2016 May;36(4):276-83. doi: 10.1002/micr.22406. Epub 2015 Mar 23.
Successful foot and ankle soft tissue reconstruction is dependent on a clear understanding of the vascular supply to the foot. The aim of this study was to identify risk factors for reconstructive failure following foot and ankle free tissue transfer.
The authors retrospectively reviewed their 17-year institutional experience with 231 foot and ankle free flaps performed in 225 patients to determine predictors of postoperative foot ischemia and flap failure. Postoperative foot ischemia was defined as ischemia resulting in tissue necrosis, separate from the reconstruction site.
Six (3%) patients developed postoperative foot ischemia, and 28 (12%) patients experienced flap failure. Chronic ulceration (P = 0.02) and an elevated preoperative platelet count (P = 0.04) were independent predictors of foot ischemia. The presence of diabetes was predictive of flap failure (P = 0.05). Flap failure rates were higher in the setting of an abnormal preoperative angiogram (P = 0.04), although the type and number of occluded arteries did not influence outcome. Foot ischemia was more frequent following surgical revascularization in conjunction with free tissue transfer and the use of the distal arterial bypass graft for flap anastomosis (P < 0.01). Overall, no differences were observed in foot ischemia (P = 0.17) and flap failure (P = 0.75) rates when the flap anastomosis was performed to the diseased artery noted on angiography, compared with an unobstructed native tibial artery.
Foot and ankle free tissue transfer may be performed with a low incidence of foot ischemia. Patients with diabetes, chronic ulceration, and an elevated preoperative platelet count are at higher risk for reconstructive failure. © 2015 Wiley Periodicals, Inc. Microsurgery 36:276-283, 2016.
足踝部软组织重建的成功取决于对足部血管供应的清晰了解。本研究的目的是确定足踝部游离组织移植后重建失败的危险因素。
作者回顾性分析了他们在17年中对225例患者进行的231例足踝部游离皮瓣手术的机构经验，以确定术后足部缺血和皮瓣失败的预测因素。术后足部缺血定义为导致组织坏死的缺血，与重建部位无关。
6例（3%）患者发生术后足部缺血，28例（12%）患者皮瓣失败。慢性溃疡（P = 0.02）和术前血小板计数升高（P = 0.04）是足部缺血的独立预测因素。糖尿病的存在可预测皮瓣失败（P = 0.05）。术前血管造影异常时皮瓣失败率较高（P = 0.04），尽管闭塞动脉的类型和数量不影响结果。在游离组织移植联合手术血管重建以及使用远端动脉搭桥进行皮瓣吻合后，足部缺血更为常见（P < 0.01）。总体而言，与通畅的胫后动脉相比，当皮瓣吻合至血管造影显示的病变动脉时，足部缺血（P = 0.17）和皮瓣失败（P = 0.75）率无差异。
足踝部游离组织移植术后足部缺血的发生率可能较低。糖尿病、慢性溃疡和术前血小板计数升高的患者重建失败风险较高。© 2015威利期刊公司。显微外科学36:276 - 283，2016年。
