Wells M D, Bowen C V, Manktelow R T, Graham J, Boyd J B
Division of Plastic and Reconstructive Surgery, University of Kentucky Medical Center, Lexington, USA.
Can J Surg. 1996 Jun;39(3):233-9.
To identify factors related to free-flap coverage of lower extremity fractures that are linked to a negative outcome.
A chart review.
A large microsurgical referral centre.
From 1981 to 1989, the records of all patients who underwent free-tissue transfer to the lower extremity with more than 1 year of follow-up were selected. From this was drawn a subgroup of 49 patients (mean age, 36 years) who had tibial fractures (55% were motor vehicle injuries) and in almost all cases established soft-tissue or bony defects. They formed the study group.
Free-flap transfer.
Factors that might be associated with free-flap failure: mechanism of injury, grade of tibial fracture, history of smoking, diabetes, peripheral vascular disease, ischemic heart disease, vascular compromise in the leg preoperatively, recipient artery used, type of anastomosis, and hypertension or hypotension intraoperatively.
Type IIIB tibial fractures were the most frequent (67%) and carried a significantly (p = 0.02) higher risk of free-flap failure than other types of fracture. Patients underwent a mean of four procedures before referral for free-tissue transfer. The mean time from injury to flap coverage was 1006 days. Stable, long-term coverage of the free flaps was achieved in 78% of patients. Wound breakdown was most often caused by recurrent osteomyelitis (65%). Seventy-four percent of the fractures healed. The amputation rate was 10%. Four patients required repeat free-flap transfer for limb salvage.
Only the grade of tibial fracture could be significantly related to postoperative free-flap failure.
确定与下肢骨折游离皮瓣覆盖相关且与不良预后有关的因素。
图表回顾。
大型显微外科转诊中心。
选取1981年至1989年期间所有接受下肢游离组织移植且随访超过1年的患者记录。从中抽取了49例患者（平均年龄36岁）组成亚组，这些患者均有胫骨骨折（55%为机动车伤），且几乎所有病例都存在软组织或骨缺损。他们构成了研究组。
游离皮瓣移植。
可能与游离皮瓣失败相关的因素：损伤机制、胫骨骨折分级、吸烟史、糖尿病、外周血管疾病、缺血性心脏病、术前腿部血管受损情况、所用受区动脉、吻合类型以及术中高血压或低血压。
III B型胫骨骨折最为常见（67%），与其他类型骨折相比，游离皮瓣失败风险显著更高（p = 0.02）。患者在转诊接受游离组织移植前平均接受了四次手术。从受伤到皮瓣覆盖的平均时间为1006天。78%的患者实现了游离皮瓣的稳定长期覆盖。伤口裂开最常见的原因是复发性骨髓炎（65%）。74%的骨折愈合。截肢率为10%。四名患者需要再次进行游离皮瓣移植以挽救肢体。
只有胫骨骨折分级与术后游离皮瓣失败显著相关。
