Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Reconstr Microsurg. 2024 May;40(4):276-283. doi: 10.1055/a-2153-4439. Epub 2023 Aug 14.
Use of pedicled flaps in vascular procedures is associated with decreased infection and wound breakdown. We evaluated the risk profile and postoperative complications associated with lower extremity open vascular procedures with and without pedicled flaps.
The American College of Surgeons National Surgical Quality Improvement Program database (2010-2020) was queried for Current Procedural Terminology codes representing lower extremity open vascular procedures, including trunk and lower extremity pedicled flaps. Flap patients were compared with a randomized control group without flaps (1:3 cases to controls). Univariate and multivariate analyses were performed.
We identified 132,934 adults who underwent lower extremity open vascular procedures. Concurrent pedicled flaps were rare (0.7%), and patients undergoing bypass procedures were more likely to receive a flap than nonbypass patients (69 vs. 64%, < 0.0001). Flap patients had greater comorbidities. On univariate analysis, flap patients were more likely to experience wound ( = 0.0026), mild systemic ( < 0.0001), severe systemic ( = 0.0452), and all-cause complications ( < 0.0001). After adjusting for factors clinically suspected to be associated with increased risk (gender, body mass index, procedure type, American Society of Anesthesiologists classification, functional status, diabetes, smoking, and albumin < 3.5 mg/dL), wound ( = 0.096) and severe systemic complications ( = 0.0719) were no longer significantly associated with flap patients.
Lower extremity vascular procedures are associated with a high risk of complications. Use of pedicled flaps remains uncommon and more often performed in patients with greater comorbid disease. However, after risk adjustment, use of a pedicled flap in high-risk patients may be associated with lower than expected wound and severe systemic complications.
在血管手术中使用带蒂皮瓣可降低感染和伤口破裂的风险。我们评估了有和没有带蒂皮瓣的下肢开放性血管手术的风险特征和术后并发症。
美国外科医师学会国家手术质量改进计划数据库（2010-2020 年）中查询了代表下肢开放性血管手术的当前操作术语代码，包括躯干和下肢带蒂皮瓣。将皮瓣患者与无皮瓣的随机对照患者（1:3 例对照）进行比较。进行了单变量和多变量分析。
我们确定了 132934 名接受下肢开放性血管手术的成年人。同期带蒂皮瓣很少见（0.7%），接受旁路手术的患者比非旁路患者更有可能接受皮瓣（69%比 64%，<0.0001）。皮瓣患者的合并症更多。在单变量分析中，皮瓣患者更容易发生伤口（=0.0026）、轻度全身性（<0.0001）、严重全身性（=0.0452）和所有原因并发症（<0.0001）。在调整了临床上怀疑与风险增加相关的因素（性别、体重指数、手术类型、美国麻醉医师协会分类、功能状态、糖尿病、吸烟和白蛋白<3.5mg/dL）后，伤口（=0.096）和严重全身性并发症（=0.0719）与皮瓣患者不再显著相关。
下肢血管手术并发症风险高。使用带蒂皮瓣仍然不常见，并且更多地用于患有更多合并症的患者。然而，在风险调整后，高危患者使用带蒂皮瓣可能与预期的伤口和严重全身性并发症发生率较低相关。
