Department of Plastic and Reconstructive Surgery and Microsurgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy.
Department of Plastic and Reconstructive Surgery and Microsurgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy.
Injury. 2019 Dec;50 Suppl 5:S11-S16. doi: 10.1016/j.injury.2019.10.039. Epub 2019 Oct 31.
The aim of this report is to compare free perforator flaps and propeller flaps in the coverage of lower limb soft tissue defects.
179 patients (age between 5 and 92 years old), underwent soft tissue reconstruction of the lower limb between January 2009 and January 2015, either by free flap or propeller flap. The two groups were retrospectively evaluated in order to assess the outcome, complications and potential risk factors. Correlations between risk factors and presence/absence of failure or complications have been evaluated with descriptive statistical analysis and a set of logistic regression models. Finally, an economic analysis was conducted to evaluate the different tecniques.
In a simple descriptive statistical analysis, the overall failure rate is 6% for free flaps and 3.7% for propeller flaps; the complication rates are 14% vs 21.5% and it increases as dimension increases. The logistic models relating failure and complications with potential risk factors do not show significant differences, whereas the economic analysis show that the average expense of free flaps is 5077.5€ per patient, 1595.6€ per patient for propeller flaps.
Our results do not demonstrate significant differences between the two groups about correlation of risk factors or flap size with complication or failure. The surgical option choice should be taken only after accurate evaluation of the soft tissue surrounding the defect. Propeller flaps should be preferred in case of small/medium size defects in otherwise healthy extremities. Free perforator flaps should be the choice in large defects due to trauma or vascular diseases. The economic analysis suggests that propeller flap should be considered when possible.
本报告旨在比较游离穿支皮瓣与旋转推进皮瓣在下肢软组织缺损覆盖中的应用。
2009 年 1 月至 2015 年 1 月，179 例患者（年龄 5-92 岁）接受了下肢软组织重建，分别采用游离皮瓣或旋转推进皮瓣。回顾性评估两组患者的治疗效果、并发症及潜在危险因素。采用描述性统计分析和一系列逻辑回归模型评估危险因素与皮瓣失败或并发症发生之间的相关性。最后，进行了一项经济分析，以评估不同技术。
在简单的描述性统计分析中，游离皮瓣的总体失败率为 6%，旋转推进皮瓣的失败率为 3.7%；并发症发生率分别为 14%和 21.5%，且随皮瓣尺寸的增加而增加。将失败和并发症与潜在危险因素相关联的逻辑模型未显示出显著差异，而经济分析表明，游离皮瓣的平均费用为每位患者 5077.5 欧元，旋转推进皮瓣为每位患者 1595.6 欧元。
我们的结果表明，两组之间在危险因素或皮瓣大小与并发症或失败的相关性方面没有显著差异。在选择手术方案时，应仅在对缺损周围的软组织进行准确评估后做出决定。在健康的四肢中，对于中小面积的缺损，应优先选择旋转推进皮瓣。对于创伤或血管疾病引起的大面积缺损，应选择游离穿支皮瓣。经济分析表明，在可能的情况下应考虑采用旋转推进皮瓣。
