From the Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine; and Department of Plastic Surgery, Asan Medical Center, University of Ulsan, School of Medicine.
Plast Reconstr Surg. 2022 Nov 1;150(5):1071e-1081e. doi: 10.1097/PRS.0000000000009646. Epub 2022 Sep 2.
Despite remarkable improvements in free flap procedures, partial flap losses in perforator flaps still occur. This study aimed to analyze partial necrosis cases that underwent reconstruction of the lower extremities using anterolateral thigh free flaps and to identify risk factors causing the occurrence of partial necrosis.
From January of 2005 to February of 2017, 303 anterolateral thigh free flaps were analyzed retrospectively. After collecting patient data, receiver operating characteristic curve analysis was conducted to find the critical distance between the perforator and the flap margin that distinguishes partial necrosis. Also, the rate of partial losses was calculated for each section after dividing the distance from the perforator to the flap margin into 1-cm sections. Lastly, logistic regression analyses were performed to identify the risk factors.
Forty-three cases had partial flap loss (14.19 percent). Flaps with supradeep fat layer elevation showed the highest rate of partial necrosis (25.53 percent), with statistical significance ( p = 0.0001). In receiver operating characteristic curve analysis, the cutoff distance was 10.25 cm. In addition, flap tissues 8 cm away from the perforator have a 10.3 percent chance of necrosis, whereas those 12 cm away from the perforator have a 22.9 percent chance. Lastly, supradeep fat layer elevation (OR, 3.952) and large flap size (OR, 1.041) were risk factors for partial flap necrosis on multivariate analysis.
The distance from the perforator to the flap margin, the flap elevation layer, and the flap size affected the occurrence of partial necrosis. Taking these into consideration, anterolateral thigh free flaps of appropriate size and thickness should be harvested.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
尽管游离皮瓣技术取得了显著的进步，但穿支皮瓣仍会出现部分皮瓣坏死。本研究旨在分析采用股前外侧皮瓣重建下肢后出现部分坏死的病例，并确定导致部分坏死发生的危险因素。
回顾性分析 2005 年 1 月至 2017 年 2 月间 303 例股前外侧皮瓣。收集患者数据后，通过接收者操作特征曲线分析确定区分部分坏死的穿支与皮瓣边缘之间的临界距离。并将穿支至皮瓣边缘的距离分为 1cm 段，计算各段的部分丢失率。最后，进行逻辑回归分析以确定危险因素。
43 例出现部分皮瓣坏死（14.19%）。带深筋膜下脂肪层抬高的皮瓣部分坏死率最高（25.53%），差异有统计学意义（p=0.0001）。在接收者操作特征曲线分析中，截断距离为 10.25cm。此外，距穿支 8cm 处的皮瓣有 10.3%的坏死风险，而距穿支 12cm 处的皮瓣有 22.9%的坏死风险。此外，深筋膜下脂肪层抬高（OR，3.952）和皮瓣较大（OR，1.041）是多因素分析中部分皮瓣坏死的危险因素。
穿支至皮瓣边缘的距离、皮瓣掀起的层次和皮瓣的大小均影响部分坏死的发生。在考虑这些因素的情况下，应选择合适大小和厚度的股前外侧皮瓣。
临床问题/证据水平：风险，III。
