带蒂皮瓣修复下肢皮肤和软组织肿瘤术后缺损延迟愈合的多因素分析

Multivariate analysis of delayed healing of pedicel flap in reconstruction of skin and soft tissue defect on the lower limbs

目的分析带蒂皮瓣修复下肢皮肤和软组织肿瘤术后软组织缺损中影响皮瓣预后的相关因素。方法统计浙江省肿瘤医院骨和软组织肿瘤外科2013年7月至2017年4月因下肢皮肤和软组织恶性肿瘤术后皮肤和软组织缺损予以带蒂皮瓣覆盖缺损的54例患者的临床资料,评价其皮瓣愈合情况,并收集患者年龄、性别、血糖、吸烟、低前清蛋白、贫血和是否行同侧腹股沟淋巴结清扫等因素,采用χ2检验筛选出危险因素后进一步采用logistic回归分析影响皮瓣延迟愈合的相关因素。结果在54例患者中,22例患者出现皮瓣延迟愈合或局部坏死。单因素χ2检验发现,皮瓣的延迟愈合与同侧腹股沟淋巴结清扫、高血压、低前清蛋白和贫血有关(P<0.05);多因素logistic回归分析显示,高血压、低前清蛋白和贫血是皮瓣愈合不良的独立危险因素(P<0.05)。结论高血压、低前清蛋白和贫血是下肢皮肤和软组织肿瘤术后缺损延迟愈合的独立危险因素。

Objective To analyze the relevant factors of delayed healing of pedicel flap in reconstruction of skin and soft tissue defect on the lower limbs. Methods From July 2013 to April 2017,clinical data of 54 patients,who suffered from skin and soft tissue defect after tumor resection and were reconstructed by pedicel flap,were enrolled statistically in Oncological Surgery of Bone and Soft Tissue of Zhejiang Cancer Hospital,and the healing was evaluated,while the age,gender,diabetes,smoking,prealbumin,anemia,whether to have ipsilateral inguinal lymph node dissection and so on were collected. The logistic regression analysis was used to analyze the related factors of flap survival after the risk factors were screened by chi-squared test.Results Among the 54 patients,delayed healing or local necrosis of pedicel flap appeared in 22 cases. The results of chisquared test showed that flap survival was related to ipsilateral inguinal lymph node dissection,hypertension,prealbumin and anemia(P<0.05). The multiple logistic regression analysis showed that hypertension,prealbumin and anemia were independent risk factors for the flap abnormal healing(P<0.05). Conclusion The hypertension,prealbumin and anemia are independent risk factor for delayed healing of pedicel flap in skin and tissue defect in limbs after tumor resection.