Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany.
Medical University of Vienna, Vienna, Austria.
Microsurgery. 2022 Oct;42(7):641-648. doi: 10.1002/micr.30934. Epub 2022 Jul 12.
Primary anterolateral thigh (ALT) flap donor-site closure is crucial to achieve patient satisfaction, avoid burdensome secondary surgeries, and avert poor outcomes. Only vague maximum flap width recommendations have been suggested, which fall short of acknowledging individual patient habitus and thigh morphology. Therefore, we aimed at identifying a user-friendly preoperative calculation of maximum flap width for primary closure.
A total of 429 ALT free flaps performed between 2009 and 2020 were analyzed. A total of 350 donor-sites were closed primarily (82%) and 79 (18%) were split-thickness skin-grafted (STSG). Patient demographics including sex, age, and BMI, operative details, and flap characteristics were compared to assess their impact on the outcome variable. Receiver operating characteristic (ROC) curves were plotted for all significant predictors discriminating between closure and STSG. Areas under the curve (AUCs) were calculated for each parameter combination and optimal cutoffs were determined using Youden's Index.
Sex, age, BMI, and flap width alone were poor discriminators. Dividing flap width by BMI and logarithmized BMI yielded AUCs of 0.91 and 0.94, respectively. Including patient sex yielded the best fitting regression model (χ = 251.939, p < .0001) increasing the AUC to 0.96 (95% CI: 0.93-0.98, p < .0001). The optimal cutoff value discriminated between primary closure and STSG with 90% sensitivity and 89% specificity. An online calculator of patient-individual maximum ALT width was then programmed.
Sex and BMI are reliable predictors of successful primary ALT donor-site closure in Caucasians. We devised a novel formula for calculating patient-individual maximum ALT widths preoperatively, predicting failure of primary closure with 90% sensitivity in our cohort, available at: https://kitteltaschenbuch.com/altwidth/calculate.htm.
实现患者满意度、避免繁琐的二次手术和避免不良结果的关键是对原发性前外侧大腿（ALT）皮瓣供区进行有效关闭。目前仅提出了一些模糊的最大皮瓣宽度建议，这些建议没有考虑到患者的个体体型和大腿形态。因此，我们旨在确定一种用户友好的原发性闭合术最大皮瓣宽度的术前计算方法。
分析了 2009 年至 2020 年间完成的 429 例 ALT 游离皮瓣。共有 350 个供区（82%）采用原发性闭合术，79 个（18%）采用中厚皮片游离移植术（STSG）。比较患者的人口统计学资料（性别、年龄和 BMI）、手术细节和皮瓣特征，以评估其对结果变量的影响。绘制所有区分闭合术和 STSG 的显著预测因素的受试者工作特征（ROC）曲线。计算每个参数组合的曲线下面积（AUC），并使用约登指数确定最佳截断值。
仅性别、年龄、BMI 和皮瓣宽度是较差的鉴别因素。将皮瓣宽度除以 BMI 和对数化 BMI，得到的 AUC 分别为 0.91 和 0.94。加入患者性别后，得到了最佳拟合的回归模型（χ²=251.939，p<.0001），AUC 增加到 0.96（95%CI：0.93-0.98，p<.0001）。最佳截断值可区分原发性闭合术和 STSG，具有 90%的敏感性和 89%的特异性。然后编写了一个用于计算患者个体最大 ALT 宽度的在线计算器。
在白种人中，性别和 BMI 是成功原发性 ALT 供区闭合术的可靠预测因素。我们设计了一种新的公式，用于术前计算患者个体的最大 ALT 宽度，在我们的队列中，该公式对原发性闭合术失败的预测具有 90%的敏感性，可在以下网址获得：https://kitteltaschenbuch.com/altwidth/calculate.htm。
