Arakelyan Sergey, Aydogan Emrah, Spindler Nick, Langer Stefan, Bota Olimpiu
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Germany.
University Center of Orthopaedic, Trauma and Plastic Surgery University Hospital Carl Gustav Carus, TU Dresden, Germany.
GMS Interdiscip Plast Reconstr Surg DGPW. 2022 Jan 14;11:Doc01. doi: 10.3205/iprs000162. eCollection 2022.
: During the past decades, free flaps have been given a central role in the reconstructive surgery. Especially in the extremities, where there is a scarcity of available tissues for local flaps, free flaps play a central part. The aim of this study was to evaluate the risk factors contributing to partial and total flap failure. : In a retrospective cohort study, all data concerning patients who underwent free flap reconstruction of the extremities during the first five years since the founding of the department of plastic surgery were gathered. Patient- and surgery-related risk factors were analyzed in correlation to the postoperative complications. : In total, 182 free flaps were included in this study. Partial and total flap failure were noted in 21.42% and 17.03%, respectively. A correlation was seen between the time lapsed from debridement until flap coverage, with flaps performed between day 4 and 14 having the least quote of flap failure (p=0.022). Gender, age, arterial hypertension, nicotine abuse, diabetes mellitus, peripheral arterial disease and the number of anastomosed veins were not significantly associated with free flap failure. : Our study showed that free flaps can be safely performed in healthy patients as well as in patients with risk factors, with an acceptable flap loss rate. Randomized controlled studies are needed to clarify the exact role of each risk factor in free flap surgery.
在过去几十年中，游离皮瓣在重建手术中发挥了核心作用。特别是在四肢部位，由于局部皮瓣可用组织匮乏，游离皮瓣起到了关键作用。本研究的目的是评估导致皮瓣部分和完全失败的风险因素。
在一项回顾性队列研究中，收集了整形外科成立后头五年内接受四肢游离皮瓣重建手术患者的所有相关数据。分析了与术后并发症相关的患者和手术相关风险因素。
本研究共纳入182例游离皮瓣。皮瓣部分和完全失败的发生率分别为21.42%和17.03%。从清创到皮瓣覆盖的时间间隔与皮瓣失败存在相关性，在第4天至第14天进行的皮瓣失败率最低（p = 0.022）。性别、年龄、动脉高血压、吸烟、糖尿病、外周动脉疾病以及吻合静脉数量与游离皮瓣失败无显著相关性。
我们的研究表明，游离皮瓣在健康患者以及有风险因素的患者中均可安全进行，皮瓣丢失率可接受。需要进行随机对照研究以明确各风险因素在游离皮瓣手术中的确切作用。
