Hu Jingjing, Wang Fei, Li Jiang, Yi Liqi, Yang Jiguo
Operating Room, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 318050 Taizhou, Zhejiang, China.
Department of Hand and Foot Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 318050 Taizhou, Zhejiang, China.
Ann Ital Chir. 2025 Jul 10;96(7):924-932. doi: 10.62713/aic.4048.
This study aimed to explore the efficacy of anterolateral thigh perforator (ALTP) flap and peroneal artery perforator (PAP) flap transplantation and their influence on levels of pain and wound growth factors in elderly patients with soft tissue defects caused by foot trauma.
A total of 98 elderly patients with foot trauma who underwent flap transplantation in the hospital from January 2022 to January 2024 were collected and analyzed retrospectively. Patients were divided into the ALTP group ( = 45, receiving ALTP flap transplantation) and the PAP group ( = 53, receiving PAP flap transplantation). Visual analogue scale (VAS) and American orthopedic foot and ankle society (AOFAS) score were used to assess the pain and functional outcome. Enzyme-linked immunosorbent assay (ELISA) kits were utilized to test the levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and hypoxia inducible factor 1 (HIF-1) in wound fluid.
The wound size in the ALTP group was larger than that in the PAP group ( < 0.001). Longer operative time, hospitalization time and greater intraoperative blood loss were noted in the ALTP group than in the PAP group ( < 0.001). Linear regression analysis showed that the surgical method was the main factor affecting operative time, hospitalization time and intraoperative blood loss ( < 0.001). The necrosis rate in the ALTP group (13.33%) was higher than that in the PAP group (3.77%), but the difference was not statistically significant ( = 0.176). Compared with the ALTP group, the VAS score of the PAP group was markedly reduced at 3 days and 1 week after surgery, and 1 month after follow-up ( < 0.001). 3 days after surgery, the levels of VEGF and bFGF of the PAP group were significantly increased compared with the ALTP group ( < 0.001). 1 week after surgery, the levels of bFGF of the PAP group were higher compared with the ALTP group ( = 0.003). The total incidence rate of complications in the ALTP group (25/44, 56.82%) was significantly higher than that in the PAP group (7/53, 13.21%) ( < 0.001). And multivariate logistic regression analysis showed that ALTP was the independent influencing factors for complications ( < 0.001). At 6 months after surgery, there was no significant difference in AOFAS scores between the two groups ( = 0.078).
ALTP and PAP flap transplantation were both suitable for the reconstruction of soft tissue defects caused by foot trauma in elderly patients, with the latter associated with shorter surgical time and hospitalization time, as well as better wound healing, less postoperative pain and fewer complications.
本研究旨在探讨股前外侧穿支（ALTP）皮瓣和腓动脉穿支（PAP）皮瓣移植治疗足部创伤致软组织缺损老年患者的疗效及其对疼痛程度和创面生长因子水平的影响。
回顾性收集并分析2022年1月至2024年1月在我院接受皮瓣移植的98例足部创伤老年患者。将患者分为ALTP组（n = 45，接受ALTP皮瓣移植）和PAP组（n = 53，接受PAP皮瓣移植）。采用视觉模拟评分法（VAS）和美国矫形足踝协会（AOFAS）评分评估疼痛情况和功能结局。使用酶联免疫吸附测定（ELISA）试剂盒检测创面渗出液中血管内皮生长因子（VEGF）、碱性成纤维细胞生长因子（bFGF）和缺氧诱导因子1（HIF-1）的水平。
ALTP组的创面面积大于PAP组（P < 0.001）。ALTP组的手术时间、住院时间更长，术中出血量更多，均高于PAP组（P < 0.001）。线性回归分析显示，手术方式是影响手术时间、住院时间和术中出血量的主要因素（P < 0.001）。ALTP组的坏死率（13.33%）高于PAP组（3.77%），但差异无统计学意义（P = 0.176）。与ALTP组相比，PAP组术后3天、1周及随访1个月时的VAS评分显著降低（P < 0.001）。术后3天，PAP组的VEGF和bFGF水平较ALTP组显著升高（P < 0.001）。术后1周，PAP组的bFGF水平高于ALTP组（P = 0.003）。ALTP组的并发症总发生率（25/44，56.82%）显著高于PAP组（7/53，13.21%）（P < 0.001）。多因素logistic回归分析显示，ALTP是并发症的独立影响因素（P < 0.001）。术后6个月，两组的AOFAS评分差异无统计学意义（P = 0.078）。
ALTP和PAP皮瓣移植均适用于足部创伤致软组织缺损老年患者的重建，后者手术时间和住院时间更短，创面愈合更好，术后疼痛更轻，并发症更少。
