Division of Plastic and Reconstructive Surgery, Stanford University, California.
Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles.
J Burn Care Res. 2020 Sep 23;41(5):967-970. doi: 10.1093/jbcr/iraa096.
Pedicled and free flaps are occasionally necessary to reconstruct complex wounds in acute burn patients. Flap coverage has classically been delayed for concern of progressive tissue necrosis and flap failure. We aim to investigate flap complications in primary burn care leveraging national U.S. data. Acute burn patients with known % total body surface area(TBSA) were extracted from the Nationwide/National Inpatient Sample from 2002 to 2014 based on the International Classification of Disease (ICD) codes, ninth edition. Variables included age, sex, race, Elixhauser index, %TBSA, mechanism, inhalation injury, and location of burn. Flap complication was defined by ICD-9 procedure code 86.75, return to the operating room for flap revision. Multivariable analysis evaluated predictors of flap compromise using stepwise logistic regression with backward elimination. The weighted sample included 306,924 encounters of which 526 received a flap (0.17%). About 7.8% of flap encounters sustained electric injury compared to 2.7% of non-flap encounters (odds ratio [OR] 3.76, 95% confidence interval [CI] 1.95-7.24, P < .001). The mean hospital day of the flap procedure was 10.1 (SD 10.7) days. Flap complications occurred in 6.4% of cases. The timing of flap coverage was not associated with complications. The only independent predictor of flap complication was electrical injury (OR 40.49, 95% CI 2.98-550.64, P = .005). Electrical injury was an independent predictor of flap complications compared to other mechanisms. Flap timing was not associated with return to surgery for complications. This suggests that the use of flaps is safe in acute burn care to achieve burn wound closure with an understanding that electrical injuries may warrant particular consideration to avoid failure.
带蒂皮瓣和游离皮瓣偶尔需要用于重建急性烧伤患者的复杂创面。由于担心进行性组织坏死和皮瓣失败，皮瓣覆盖术传统上被延迟。我们旨在利用美国全国范围的数据来研究初级烧伤护理中的皮瓣并发症。根据国际疾病分类（ICD）第 9 版代码，从 2002 年至 2014 年，从全国/全国住院患者样本中提取出已知总体表面积（TBSA）%的急性烧伤患者。变量包括年龄、性别、种族、Elixhauser 指数、%TBSA、机制、吸入性损伤和烧伤部位。皮瓣并发症通过 ICD-9 手术代码 86.75 定义，即皮瓣修正术返回手术室。使用逐步逻辑回归进行多变量分析，采用向后消除法评估皮瓣损伤的预测因素。加权样本包括 306924 次就诊，其中 526 次接受皮瓣（0.17%）。与非皮瓣就诊（比值比 [OR] 3.76，95%置信区间 [CI] 1.95-7.24，P <.001）相比，约 7.8%的皮瓣就诊发生电击伤。皮瓣手术的平均住院日为 10.1（SD 10.7）天。皮瓣并发症发生率为 6.4%。皮瓣覆盖的时间与并发症无关。皮瓣并发症的唯一独立预测因素是电损伤（OR 40.49，95%CI 2.98-550.64，P =.005）。与其他机制相比，电损伤是皮瓣并发症的独立预测因素。皮瓣时机与并发症再次手术无关。这表明，在急性烧伤护理中使用皮瓣来实现烧伤创面闭合是安全的，应了解电损伤可能需要特别注意以避免失败。
