Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, 5-54 Ujinakanda, Hiroshima, Japan.
Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2515-2523. doi: 10.1007/s00590-022-03467-w. Epub 2022 Dec 27.
This study aims to identify serum biomarkers that contribute to vascular thrombosis and complete flap failure in delayed reconstruction with free flaps, as well as to develop a scoring system of risk assessment including these biomarkers.
A retrospective review of the database was conducted for lower extremity open fractures reconstructed between 7 and 90 days from injury, from March 2014 to February 2022. We investigated changes in platelet count (PLT), D-dimer, creatine phosphokinase (CPK), and C-reactive protein (CRP) and then, developed a risk assessment system including these biomarkers as risk factors.
A total of 62 free flaps were enrolled, and vascular thrombosis occurred in 14 flaps (22.6%), 9 of which (14.5%) developed complete flap failure. The risk assessment score was set to a maximum of 6 points for 6 items: age ≤ 40 years, time from injury to coverage ≥ 14 days, zone of injury from middle to distal leg, D-dimer on the day of injury ≥ 60 µg/mL, maximum value of CPK ≥ 10,000 U/L, and maximum value of CRP ≥ 25 mg/dL. The best cutoff score was 3 in the vascular thrombosis model (sensitivity: 0.79, specificity: 0.77) and 4 in the complete flap failure model (sensitivity: 0.78, specificity: 0.92).
Our risk assessment system showed that the risk of vascular thrombosis was high at ≥ 3 points and that of complete flap failure was high at ≥ 4 points. Significantly, elevated levels of D-dimer, CPK, and CRP require more caution during reconstruction using free flaps.
本研究旨在确定游离皮瓣延迟重建中导致血管血栓形成和完全皮瓣失败的血清生物标志物，并建立一个包含这些生物标志物的风险评估评分系统。
对 2014 年 3 月至 2022 年 2 月期间因下肢开放性骨折受伤后 7 至 90 天进行重建的游离皮瓣患者的数据库进行回顾性分析。我们研究了血小板计数（PLT）、D-二聚体、肌酸磷酸激酶（CPK）和 C 反应蛋白（CRP）的变化，并在此基础上建立了一个包含这些生物标志物作为危险因素的风险评估系统。
共纳入 62 例游离皮瓣，其中 14 例（22.6%）发生血管血栓形成，其中 9 例（14.5%）出现完全皮瓣失败。风险评估评分最高设为 6 分，共 6 项：年龄≤40 岁、受伤至覆盖时间≥14 天、损伤区从中段至下段小腿、伤后第 1 天 D-二聚体≥60μg/mL、CPK 最高值≥10,000 U/L、CRP 最高值≥25mg/dL。在血管血栓形成模型中，最佳截断值为 3 分（灵敏度：0.79，特异性：0.77），在完全皮瓣失败模型中，最佳截断值为 4 分（灵敏度：0.78，特异性：0.92）。
我们的风险评估系统显示，血管血栓形成的风险在≥3 分时较高，完全皮瓣失败的风险在≥4 分时较高。D-二聚体、CPK 和 CRP 水平升高显著，在使用游离皮瓣重建时需要更加小心。
