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Abstract：
OBJECTIVE: Free flaps are widely used for the repair of soft tissue defects in the lower limbs, but there is still a specific rate of necrosis. Few clinical retrospective studies have analyzed the nontechnical risk factors for lower limb free flap necrosis. This study aimed to analyze the nontechnical causes of flap necrosis in lower limb soft tissue reconstruction in order to identify risk factors and improve the survival rate of free flaps.
METHODS: Clinical data from 244 cases of soft tissue defects of the leg or foot that were repaired with a free flap from January 2011 to June 2020 were retrospectively analyzed. The flap results were divided into complete survival and necrosis groups. The patients\' general information, smoking history, soft tissue defect site, Gustilo-Anderson classification, shock after injury, type and size of the flap, and time from injury to flap coverage were recorded. A logistic regression model was used to analyze the correlations between flap necrosis and possible risk factors.
RESULTS: Of the 244 flaps, 32 suffered from partial or total necrosis, and 212 completely survived. Univariate analysis showed that age, smoking history, soft tissue defect site, and time from injury to flap coverage were significantly correlated with flap necrosis (p ≤ 0.2). Multivariate logistic regression analysis showed that moderate-to-severe smoking history (p < 0.001, odds ratio [OR] = 10.259, 95% confidence interval [CI] = 2.886-36.468), proximal leg defect (p = 0.006, OR = 7.095, 95% CI = 1.731-29.089), and time from injury to flap coverage >7 days (p = 0.003, OR = 12.351, 95% CI = 2.343-65.099) were statistically significant risk factors for flap necrosis (p < 0.05), and age was excluded (p = 0.666; p = 0.924).
CONCLUSIONS: The risk of flap necrosis was significantly increased when the soft tissue defect was located in the proximal leg, the time from injury to flap coverage was >7 days, and the patient had a moderate-to-severe smoking history. These three risk factors have an increased influence on flap necrosis and have guiding significance in predicting flap prognosis.
METHODS: Clinical data from 244 cases of soft tissue defects of the leg or foot that were repaired with a free flap from January 2011 to June 2020 were retrospectively analyzed. The flap results were divided into complete survival and necrosis groups. The patients\' general information, smoking history, soft tissue defect site, Gustilo-Anderson classification, shock after injury, type and size of the flap, and time from injury to flap coverage were recorded. A logistic regression model was used to analyze the correlations between flap necrosis and possible risk factors.
RESULTS: Of the 244 flaps, 32 suffered from partial or total necrosis, and 212 completely survived. Univariate analysis showed that age, smoking history, soft tissue defect site, and time from injury to flap coverage were significantly correlated with flap necrosis (p ≤ 0.2). Multivariate logistic regression analysis showed that moderate-to-severe smoking history (p < 0.001, odds ratio [OR] = 10.259, 95% confidence interval [CI] = 2.886-36.468), proximal leg defect (p = 0.006, OR = 7.095, 95% CI = 1.731-29.089), and time from injury to flap coverage >7 days (p = 0.003, OR = 12.351, 95% CI = 2.343-65.099) were statistically significant risk factors for flap necrosis (p < 0.05), and age was excluded (p = 0.666; p = 0.924).
CONCLUSIONS: The risk of flap necrosis was significantly increased when the soft tissue defect was located in the proximal leg, the time from injury to flap coverage was >7 days, and the patient had a moderate-to-severe smoking history. These three risk factors have an increased influence on flap necrosis and have guiding significance in predicting flap prognosis.
摘要：
目的：游离皮瓣广泛用于修复下肢软组织缺损，但仍有特定的坏死率。很少有临床回顾性研究分析下肢游离皮瓣坏死的非技术性危险因素。本研究旨在分析下肢软组织重建中皮瓣坏死的非技术原因，以确定危险因素，提高游离皮瓣的成活率。
方法：回顾性分析2011年1月至2020年6月采用游离皮瓣修复的244例腿部或足部软组织缺损患者的临床资料。皮瓣结果分为完全存活组和坏死组。患者的一般信息，吸烟史,软组织缺损部位,Gustilo-Anderson分类,受伤后休克,皮瓣的类型和尺寸，记录从损伤到皮瓣覆盖的时间。采用logistic回归模型分析皮瓣坏死与可能危险因素的相关性。
结果：在244个襟翼中，32患有部分或完全坏死，212人活了下来。单因素分析显示,年龄,吸烟史,软组织缺损部位,从损伤到皮瓣覆盖的时间与皮瓣坏死显着相关（p≤0.2）。多因素logistic回归分析显示中重度吸烟史(p<0.001,比值比[OR]=10.259,95%置信区间[CI]=2.886-36.468),腿近端缺损(p=0.006,OR=7.095,95%CI=1.731-29.089),从损伤到皮瓣覆盖>7天的时间（p=0.003，OR=12.351，95％CI=2.343-65.099）是皮瓣坏死的有统计学意义的危险因素（p<0.05），年龄排除（p=0.666；p=0.924）。
结论：当软组织缺损位于腿近端时，皮瓣坏死的风险明显增加，从受伤到皮瓣覆盖的时间>7天，患者有中重度吸烟史.3种危险因素对皮瓣坏死的影响增加,对预测皮瓣预后具有指导意义。
方法：回顾性分析2011年1月至2020年6月采用游离皮瓣修复的244例腿部或足部软组织缺损患者的临床资料。皮瓣结果分为完全存活组和坏死组。患者的一般信息，吸烟史,软组织缺损部位,Gustilo-Anderson分类,受伤后休克,皮瓣的类型和尺寸，记录从损伤到皮瓣覆盖的时间。采用logistic回归模型分析皮瓣坏死与可能危险因素的相关性。
结果：在244个襟翼中，32患有部分或完全坏死，212人活了下来。单因素分析显示,年龄,吸烟史,软组织缺损部位,从损伤到皮瓣覆盖的时间与皮瓣坏死显着相关（p≤0.2）。多因素logistic回归分析显示中重度吸烟史(p<0.001,比值比[OR]=10.259,95%置信区间[CI]=2.886-36.468),腿近端缺损(p=0.006,OR=7.095,95%CI=1.731-29.089),从损伤到皮瓣覆盖>7天的时间（p=0.003，OR=12.351，95％CI=2.343-65.099）是皮瓣坏死的有统计学意义的危险因素（p<0.05），年龄排除（p=0.666；p=0.924）。
结论：当软组织缺损位于腿近端时，皮瓣坏死的风险明显增加，从受伤到皮瓣覆盖的时间>7天，患者有中重度吸烟史.3种危险因素对皮瓣坏死的影响增加,对预测皮瓣预后具有指导意义。
