游离背阔肌皮瓣术后远端部分坏死的相关因素分析

Analysis of related factors of distal partial necrosis after operation of free latissimus dorsi flap

目的探讨游离背阔肌皮瓣修复四肢创面时远端部分坏死的相关影响因素。方法对我院自2015年1月至2021年12月应用游离背阔肌皮瓣修复四肢创面的49例患者进行回顾性分析,以皮瓣是否发生部分坏死为结局指标,以性别、年龄、基础疾病、吸烟史、身体质量指数(BMI)、肢别、致伤原因、受伤至皮瓣手术时间、皮瓣术前血红蛋白值、创面是否合并感染、皮瓣面积、血管吻合方式、吻合血管动静脉比例为自变量,采用二分类Logistic回归模型进行单因素和多因素分析。结果 49例游离背阔肌皮瓣中有13例皮瓣远端发生部分坏死,坏死面积5 cm×7 cm~10 cm×7 cm。通过单因素及多因素分析认为游离背阔肌皮瓣术后远端部分坏死的影响因素包括:年龄、血红蛋白、受伤至皮瓣手术时间、皮瓣面积、创面合并感染与皮瓣动脉血管吻合方式。结论年龄、血红蛋白、受伤至皮瓣手术时间、皮瓣面积、创面合并感染与皮瓣动脉血管吻合方式是导致游离背阔肌皮瓣术后远端部分坏死的独立危险因素,提示及时纠正贫血、控制感染、术后早期修复创面、通过内增压等方式增加远端皮瓣供血是促进皮瓣远端存活的有利措施。

Objective To investigate the related factors of distal necrosis in the repair of limb wounds with free latissimus dorsi flap.Methods From January 2015 to December 2021,49 patients with limb wounds repaired with free latissimus dorsi myocutaneous flap in our hospital were retrospectively analyzed.The outcome index was whether the flap had partial necrosis.The independent variable was gender,age,basic disease,smoking history,body mass index(BMI),limb type,cause of injury,time from injury to flap operation,hemoglobin value before flap operation,whether the wound was complicated with infection,flap area,the mode of vascular anastomosis and the proportion of anastomotic artery and vein.The binary Logistic regression model was used for univariate and multivariate analysis.Results Among 49 free latissimus dorsi flaps,13 cases had partial necrosis at the distal end of the flap,with a necrosis area of 5 cm×7 cm to 10 cm×7 cm.Through univariate and multivariate analysis,it is considered that the influencing factors of distal necrosis of free latissimus dorsi flap include age,hemoglobin,time from injury to flap operation,flap area,wound co-infection and flap artery anastomosis.Conclusion The age,hemoglobin,time from injury to flap operation,flap area,wound co-infection and flap artery anastomosis are independent risk factors for distal partial necrosis of free latissimus dorsi flap after operation,suggesting that timely correction of anemia,control of infection,early postoperative repair of wound,and increase of distal flap blood supply through internal pressurization are beneficial measures to promote distal flap survival.