MEDLINE/PubMed Journal Browser Search

Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

Title: [Clinical study of modified technique to reduce partial necrosis rate of distally pedicled sural flap].
Author: Peng P, Dong Z, Liu L, Wei J, Luo Z, Cao S.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Jun 15; 35(6):750-755. PubMed ID: 34142503.
Abstract:
OBJECTIVE: To investigate whether the technical modifications regarding the risk factors related to the partial necrosis of the distally pedicled sural flap could reduce the partial necrosis rate of the flap. METHODS: A clinical data of 254 patients (256 sites) (modified group), who used modified technique to design and cut distally pedicled sural flaps to repair the distal soft tissue defects of the lower limbs between April 2010 and December 2019, was retrospectively analyzed. Between April 2001 and March 2010, 175 patients (179 sites) (control group) who used the traditional method to design and cut the skin flap to repair the distal soft tissue defects of the lower limbs were compared. Various technical modifications were used to lower the top-edge of the flap, reduce the length-width ratio (LWR) of the flap and width of the skin island. There was no significant difference in gender, age, etiology, duration from injury to operation, site and area of the soft tissue defect between groups ( P>0.05). The length and width of the skin island and adipofascial pedicle, the total length of the flap and LWR, and the pivot point position were measured and recorded. The top-edge of the flap was determined according to the division of 9 zones in the posterior aspect of the lower limb. The occurrence of partial necrosis of the flap and the success rate of defect reconstruction were observed postoperatively. RESULTS: There was no significant difference in the length and width of the skin island, the length of the adipofascial pedicle, total length and LWR of the flap, and pivot point position of the flap between groups ( P>0.05). The width of the adipofasical pedicle in modified group was significant higher than that in control group ( t=-2.019, P=0.044). The top-edge of 32 flaps (17.88%) in control group and 31 flaps (12.11%) in modified group were located at the 9th zone; the constituent ratio of the LWR more than 5∶1 in modified group (42.58%, 109/256) was higher than that in control group (42.46%, 76/179); and the constituent ratio of width of skin island more than 8 cm in control group (59.78%, 107/179) was higher than that in modified group (57.42%, 147/256). There was no significant difference in the above indicators between groups ( P>0.05). In control group, 155 flaps (86.59%) survived completely, 24 flaps (13.41%) exhibited partial necrosis. Among them, 21 wounds healed after symptomatic treatments, 3 cases were amputated. The success rate of defects reconstruction was 98.32% (176/179). In modified group, 241 flaps (94.14%) survived completely, 15 flaps (5.86%) exhibited partial necrosis. Among them, 14 wounds healed after symptomatic treatments, 1 case was amputated. The success rate of defect reconstruction was 99.61% (255/256). The partial necrosis rate in modified group was significantly lower than that in control group ( χ ²=7.354, P=0.007). There was no significant difference in the success rate between the two groups ( P=0.310). All patients in both groups were followed up 1 to 131 months (median, 9.5 months). All wounds in the donor and recipient sites healed well. CONCLUSION: The partial necrosis rate of the distally based sural flap can be decreased effectively by applying personalized modified technical for specific patients. 目的: 探讨针对远端蒂腓肠皮瓣部分坏死危险因素进行的多种技术改良能否降低该皮瓣部分坏死率。. 方法: 回顾分析 2010 年 4 月—2019 年 12 月，采用改良技术设计并切取远端蒂腓肠皮瓣进行下肢远端皮肤软组织缺损修复的 254 例（256 处）患者（改良组）临床资料，并与 2001 年 4 月—2010 年 3 月采用传统方法设计并切取该皮瓣进行下肢远端软组织缺损修复的 175 例（179 处）患者（对照组）进行比较。通过改良技术降低皮瓣近端位置、减小皮瓣长宽比和瓣部宽度。两组患者性别、年龄、致伤原因、受伤至手术时间、软组织缺损部位及缺损范围等一般资料比较，差异均无统计学意义（ P>0.05）。测量并计算皮瓣瓣部及筋膜蒂长度、宽度，皮瓣总长及长宽比，旋转点位置；根据小腿后方 9 分区明确皮瓣近端位置；术后观察皮瓣部分坏死发生情况、创面成功修复率。. 结果: 两组皮瓣瓣部长度及宽度、筋膜蒂长度、皮瓣总长及长宽比以及旋转点位置比较，差异均无统计学意义（ P>0.05）。改良组皮瓣筋膜蒂宽度明显大于对照组（ t=–2.019， P=0.044）。对照组 32 处（17.88%）、改良组 31 处（12.11%）皮瓣近端位于第 9 区；改良组 42.58%（109 处）皮瓣长宽比超过 5∶1，高于对照组42.46%（76 处）；改良组 57.42%（147 处）皮瓣瓣部宽度超过 8 cm，明显低于对照组 59.78%（107 处）；但上述指标组间差异均无统计学意义（ P>0.05）。对照组术后皮瓣完全成活 155 处（86.59%）、部分坏死 24 处（13.41%），其中 21 处经对症处理后创面愈合、3 处最终截肢；创面成功修复率为 98.32%（176/179）。改良组术后皮瓣完全成活 241 处（94.14%）、部分坏死 15 处（5.86%），其中 14 处经对症处理后创面愈合、1 处最终截肢；创面成功修复率为 99.61%（255/256）。改良组皮瓣部分坏死率低于对照组，差异有统计学意义（ χ ²=7.354， P=0.007）；两组创面成功修复率差异无统计学意义（ P=0.310）。两组患者均获随访，随访时间 1～131 个月，中位时间 9.5 个月。随访期间供受区创面均愈合良好。. 结论: 针对患者自身情况，选择个性化改良技术可有效地降低远端蒂腓肠皮瓣的部分坏死率。.

[Abstract] [Full Text] [Related] [New Search]