游离皮瓣坏死的危险因素：多变量Logistic回归分析  

Risk factors of free flap necrosis： Multivariate Logistic regression analysis

作　　者：彭城[1] 黎蕊 黄东旭[1] 郑笑天[1] 宫旭[1] 

机构地区：[1]吉林大学白求恩第一医院手足外科,长春130021

出　　处：《中华显微外科杂志》2017年第4期337-341,共5页Chinese Journal of Microsurgery

摘　　要：目的总结游离股前外侧皮瓣坏死的影响因素，探究游离皮瓣坏死的影响因素。方法对2001年至2016年188例游离股前外侧皮瓣20个影响因素（患者特点：年龄、性别、吸烟、糖尿病、高血压；术前因素：受伤部位、受伤原因、术前创面感染、术前创面骨髓炎、受伤至手术时间；术中因素：术者、手术时间、麻醉时间、术中补液量、血管吻合方式、静脉吻合数量、皮瓣面积；术后因素：皮瓣下血肿、皮瓣感染、血管危象）进行统计．将这些影响因素与皮瓣坏死结果进行多变量Logistic回归分析。结果188例游离股前外侧皮瓣成活174例（92．55％），发生血管危象23例（12．23％），动脉危象8例、静脉危象11例、动静脉危象4例，经探查后抢救成功5例（38．46％）。经统计学分析得出：静脉吻合数量、皮瓣下血肿、血管危象与游离皮瓣坏死相关。结论静脉血管吻合数（≥2）会增加血液回流，使皮瓣更易成活。术中精确止血和安置好引流管会减少皮瓣血肿．可以减少皮瓣坏死。及时发现动静脉危象并处理．可以提高皮瓣成活率。Objective To explore the related factors with skin flap necrosis, we concluded the cases of patients with skin defects after free flap plantation. Methods From 2001 to 2016, 188 cases about 20 influencing factors were analyzed （The characteristics of patients： age, sex, smoke, diabetes, high blood pressure; Preoperative factors： injured sections, injured causes, preoperative wound infection, preoperative wound osteomyelitis, the time from injury to operation; Intraoperative factors： operator, operation time, anesthesia time, intraoperative rehydration fluids, the way of vascular anastomosis, the number of venous anastomosis, the area of flap; Postoperative factors： flap hematoma, flap infection, vascular crisis） and multivariate logistic regression analysis was used to analyze the relationship between these risk factors and flap necrosis. Results All 188 cases were treated with free anterolateral thigh flap to repair soft tissue defect and it was revealed that the 174 cases were successful （92.55%） and 23 cases were occured vascu- lar crisis （12.23%）, 8 cases were arterial crisis, 11 cases were vein crisis, 4 cases were ateriovenous crisis. After the treatment, the rescue was successful in 5 cases （38.46%）. After the analysis we made the conclusion that the number of venous anastomoses, flap hematoma and vascular crisis were related with the skin flap necrosis. Conclusion The number of venous anastomose （≥ 2） will increase blood return to make the flap easier to survive. Intraoperative stanching and drainage tube placement work will reduce the skin flap hematoma as a result of reducing the skin flap necrosis. Artery and venous crisis handled in time, can enhance the survival rate of flap.

关 键 词：股前外侧皮瓣 血管危象 坏死 回归分析 

分 类 号：R622[医药卫生—整形外科]