List Emile B, Hahn Brett A, Qiu Shan S, de Jong Tim, Rakhorst Hinne A, Verheul Elfi M, Maarse Wiesje, Coert J Henk, Krijgh David D
Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
J Reconstr Microsurg. 2024 Dec 20. doi: 10.1055/a-2483-5388.
Free tissue transplantations are commonly used to treat complex lower extremity defects caused by trauma, vascular disease, or malignancy, particularly when vital structures are exposed. This study aimed to expand the knowledge on patient-reported outcomes by comparing fasciocutaneous and muscle flaps, with the goal of facilitating patient counseling. Additionally, patient-level risk factors associated with decreased functioning and health-related quality of life were identified.
This retrospective, cross-sectional, multicenter study included patients who underwent microsurgical lower extremity reconstruction using free fasciocutaneous or muscle flaps between 2003 and 2021, with a minimum follow-up of 12 months. Data were collected from medical records, pain scores, Short-Form 36 (SF-36), and Lower Extremity Functional Scale (LEFS). Mean scores were compared between flap types and predictors of LEFS, SF-36 mental component summary (MCS), and SF-36 physical component summary (PCS) scores were determined using a backward stepwise regression model.
Of the 206 patients eligible, 100 (49%) were included in the retrospective part. A total of 89 (43%) responded to the questionnaires, with 62 treated using a fasciocutaneous flap and 27 with a muscle flap. No significant differences in total LEFS, SF-36 PCS, or MCS scores were found between the two flap type. Pain was a significant predictor of decreased functional outcomes for both flap types and was also linked to poorer mental health in patients treated with fasciocutaneous flaps. Other predictors of low patient-reported outcome scores included obesity, diabetes, poorer mental health, and a follow-up of less than 2 years.
Patients treated with fasciocutaneous and muscle flaps experience comparable levels of functionality and quality of life after surgery. Flap selection should be based on defect characteristics, along with the surgeon's individual skills and preferences. A comprehensive approach that considers physical comorbidities, pain, and mental health is essential, as these factors significantly impact patient functionality and quality of life.
游离组织移植常用于治疗由创伤、血管疾病或恶性肿瘤引起的复杂下肢缺损，尤其是在重要结构暴露时。本研究旨在通过比较筋膜皮瓣和肌皮瓣，扩大对患者报告结局的认识，以促进患者咨询。此外，还确定了与功能下降和健康相关生活质量相关的患者层面风险因素。
这项回顾性、横断面、多中心研究纳入了2003年至2021年间接受游离筋膜皮瓣或肌皮瓣显微外科下肢重建的患者，最短随访12个月。数据收集自医疗记录、疼痛评分、简明健康状况调查量表（SF-36）和下肢功能量表（LEFS）。比较了两种皮瓣类型的平均得分，并使用向后逐步回归模型确定了LEFS、SF-36心理成分总结（MCS）和SF-36身体成分总结（PCS）得分的预测因素。
在206名符合条件的患者中，100名（49%）被纳入回顾性研究部分。共有89名（43%）患者回复了问卷，其中62名接受了筋膜皮瓣治疗，27名接受了肌皮瓣治疗。两种皮瓣类型在总LEFS、SF-36 PCS或MCS得分上没有显著差异。疼痛是两种皮瓣类型功能结局下降的重要预测因素，并且与接受筋膜皮瓣治疗患者的心理健康较差有关。患者报告结局得分较低的其他预测因素包括肥胖、糖尿病、心理健康较差以及随访时间少于2年。
接受筋膜皮瓣和肌皮瓣治疗的患者术后功能和生活质量水平相当。皮瓣选择应基于缺损特征以及外科医生的个人技能和偏好。考虑身体合并症、疼痛和心理健康的综合方法至关重要，因为这些因素会显著影响患者的功能和生活质量。
