标题：股前外侧游离皮瓣移植修复四肢创伤性软组织缺损的疗效及皮瓣坏死的危险因素分析

      作者：王国辉，郭雪鹏，庹章强，尹明明，周波    安康市人民医院手足显微烧伤外科，陕西 安康 725000

      卷次： 2022年33卷15期

      【摘要】 目的 观察股前外侧区游离皮瓣移植修复四肢创伤性软组织缺损的疗效并分析皮瓣坏死的危险因素。方法 回顾性分析2017年5月至2021年5月安康市人民医院手足显微烧伤外科收治的80例四肢创伤性软组织缺损患者的临床诊治资料，将2017年5月至2019年5月收治的42例分为观察组，2019年6月至2021年5月收治的38例为对照组，其中对照组均接受了传统皮肤移植术，观察组接受了股前外侧区游离皮瓣移植。比较两组患者临床指标，术后皮瓣成活率，采用单因素和多因素Logistic回归分析皮瓣坏死的危险因素。结果 观察组患者手术时间和住院时间分别为(170.30±22.65) min、(21.64±3.25) d，明显短于对照组的(224.23±25.29) min、(30.71±3.62) d，术中出血量为(132.52±20.28) mL，明显少于对照组的(171.61±22.34) mL，差异均有统计学意义(P<0.05)；观察组患者皮瓣成活率为92.86%，明显高于对照组的73.68%，差异有统计学意义(P<0.05)；多因素Logistic分析结果显示，术中止血不彻底、吻合血管选择不当、抗生素应用不合理、并发感染、固定不牢靠是四肢创伤性软组织缺损患者术后皮瓣坏死的独立危险因素(P<0.05)。结论 股前外侧区游离皮瓣移植有利于改善四肢创伤性软组织缺损患者的临床指标，提高皮瓣成活率，促进恢复；止血不彻底、吻合血管选择不当、抗生素应用不合理、并发感染、固定不牢靠是四肢创伤性软组织缺损患者术后皮瓣坏死的独立危险因素。
      【关键词】 股前外侧区；游离皮瓣移植；四肢创伤；软组织缺损；皮瓣坏死
      【中图分类号】 R641 【文献标识码】 A 【文章编号】 1003—6350（2022）15—1954—04

Effect of anterolateral femoral free flap transplantation in repairing traumatic soft tissue defect of limbs and riskfactors of flap necrosis.
WANG Guo-hui, GUO Xue-peng, TUO Zhang-qiang, YIN Ming-ming, ZHOU Bo. Department ofHand and Foot Micro-Burn Surgery, Ankang People's Hospital, Ankang 725000, Shaanxi, CHINA
【Abstract】 Objective To observe the effect of free anterolateral femoral skin flap transplantation in the repairof traumatic soft tissue defects of limbs and to analyze the risk factors of skin flap necrosis.Methods The clinical diag-nosis and treatment data of 80 patients with traumatic soft tissue defect of limbs admitted to the Department of Hand andfoot Micro-Burn Surgery in Ankang People's Hospital from May 2017 to May 2021 were retrospectively analyzed.Among them, the 42 patients admitted from May 2017 to May 2019 were enrolled as observation group, and 38 patientsadmitted from June 2019 to May 2021 were enrolled as control group. The control group received traditional skin trans-plantation, and the observation group received anterolateral femoral free flap transplantation. The clinical indicators andpostoperative flap survival rate were compared between the two groups, and the risk factors of flap necrosis were analyzedby univariate and multivariate Logistic regression. Results The operation time and length of hospital stay in the observa-tion group were (170.30±22.65) min and (21.64±3.25) d, respectively, significantly shorter than (224.23±25.29) min and(30.71±3.62) d in the control group, and the intraoperative blood loss was (132.52±20.28) mL, significantly lower than(171.61±22.34) mL in the control group, with statistically significant differences (P<0.05). The skin flap survival rate ofthe observation group was 92.86%, which was significantly higher than 73.68% of control group (P<0.05). Multivariatelogistic analysis showed that incomplete intraoperative hemostasis, improper selection of anastomotic vessels, unreason-able application of antibiotics, concurrent infection, and unstable fixation were independent risk factors for postoperativeflap necrosis in patients with traumatic soft tissue defects of limbs (P<0.05). Conclusion The anterolateral femoral freeflap transplantation is beneficial to improve the clinical indicators of the patients with traumatic soft tissue defects oflimbs, improve the survival rate of the flap, and promote the recovery. Incomplete hemostasis, improper selection ofanastomotic vessels, unreasonable application of antibiotics, concurrent infection, and unstable fixation are the indepen-dent risk factors for postoperative flap necrosis in patients with traumatic soft tissue defects of limbs.
      【Key words】 Anterolateral femoral region; Free flap transplantation; Limb trauma; Soft tissue defect; Skin flapnecrosis