旋股外侧动脉降支穿支皮瓣供区直接闭合的可靠切取宽度及其影响因素分析

A reliable parameter for primary closure of the donor site of the descending branch of the circumflex femorallateral artery perforator flap and analysis its effective factors

目的探讨旋股外侧动脉降支穿支皮瓣供区直接闭合的可靠切取宽度及其影响因素。方法收集2013年8月至2015年12月我科完成的旋股外侧动脉降支穿支皮瓣移植患者149例，分为供区直接闭合组135例与不能直接闭合组14例。采用ROC曲线分析皮瓣供区的可靠切取宽度。在149例患者中,随机收集其中79例患者的相关基本参数，包括年龄、性别、体重指数、卧床时间、髂前上棘至髌骨外上缘连线的中点平面的大腿周径、皮下脂肪厚度以及采用＂皮肤提捏法＂评估供区的皮瓣可靠切取宽度。采用线性回归法评估影响供区的最大皮瓣可供切取宽度的相关基本因素，Pearson检验分析其相关性。结果纳入的病例中供区直接闭合135例，需要局部带蒂皮瓣、植皮或皮肤延展器闭合创面14例。采用ROC曲线分析提示皮瓣切取宽度小于8.75 cm是供区能够直接缝合的合适界限。＂皮肤提捏法＂估计的皮瓣可靠切取宽度为（8.37±1.67）cm，其中男性的皮瓣可靠切取宽度为（8.55±1.65）cm,女性为（7.42±1.5）cm，二者间差异有统计学意义（P 〈 0.05）。＂皮肤提捏法＂估计的皮瓣可靠切取宽度与大腿周径的比率（W/C%）为（17.23±3.84）%。W/C%与皮下脂肪的厚度（R=-0.299, P 〈 0.05）、体重指数（R=-0.21, P 〈 0.05）呈负相关。结论旋股外侧动脉降支穿支皮瓣的切取宽度小于8.75 cm是供区能够直接缝合的合适界限。患者的体重指数与供区皮下脂肪的厚度是影响皮瓣最大可靠切取宽度的重要因素。

ObjectiveTo explore a reliable parameter for primary closure of the donor site of the descending branch of the circumflex femoral lateral artery perforator flap and analysis its effective factors.MethodsBetween August, 2014 and December, 2015, 149 patients undergoing reconstructive procedures using the descending branch of the circumflex femoral lateral artery perforator flaps were included in the study. All patients were divided into two groups： primary closure of the donor site （135 cases） and none primary closure of the donor site （14 cases） . The receiver operating characteristic curve for biostatistical analysis was performed to identify the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap. The parameter, including the age, patients’ body mass index, subcutaneous fat thickness, thigh circumference and the maximum flap width, were recorded in 79 patients who were randomly choose from all patients. The method through stretching donor site skin was used to assess the maximum flap width. The maximum flap width-to-thigh circumference ratio was calculated. The Pearson test was used to analysis the correction between those parameters.ResultsPrimary closure of the donor site was possible in 135 patients and impossible in 14 patients. The receiver operating characteristic curve for biostatistical analysis identifying the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap was 8.75㎝. The method assessed the reliable width of the flap was （8.37±1.67） cm through stretching donor site skin. the reliable width of the flap was （8.55±1.65） cm in the male patients and （7.42±1.5） cm in the female patients. Primary closure can be achieved if the flap width-to-thigh circumference ratio was less than （17.23±3.84） percent. There was a significant negative correlation between subcutaneous fat thickness and the ratio （R=-0.299, P 〈 0.05） and between body mass index and the ratio （R=-0.21, P 〈 0.05） .ConclusionThe width of flap less than 8.75㎝ is a reliable parameter for primary closure of the descending branch of the circumflex femoral lateral artery perforator flap donor site. The patient’s body mass index and subcutaneous fat thickness of the thigh should be taken into consideration.