Issue 05 · Volume 39 · June 2023
HIGHLIGHTED ARTICLES
Journal of Reconstructive Microsurgery 最新一期现已上线,欢迎免费阅读本期精选论文。
前脚掌的缺陷经常需要进行显微外科重建;然而,重建失败会导致不如原发性截肢的结果。本研究的目的是确定影响这些患者的手术结果和住院时间的独立因素。
Original Article
Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction
Michael S Mayr-Riedler, Alexander Wacker, Florian Gedrich, Milomir Ninkovic, Hans-Günther Machens, Mirko Dozan, P. Niclas Broer
Background Defects at the forefoot frequently require microsurgical reconstruction; however, reconstructive failure can lead to results inferior to primary amputation. The purpose of this study was to identify independent factors affecting surgical outcomes and hospitalization time in these patients.
Methods All patients that underwent free flap reconstruction of the forefoot between 2008 and 2019 were reviewed retrospectively. Statistical evaluation included binary logistic regression and correlation analysis.
Results A total of 93 free flap procedures were performed in 87 patients. The most common defect etiologies were acute trauma (30 cases; 32.3%), diabetic foot syndrome (20 cases; 21.5%), and infection (17 cases; 18.3%). Muscle flaps were used in 50 cases (53.8%) and fasciocutaneous flaps were used in 43 cases (46.2%). Major complications occurred in 24 cases (25.8%) including 11 total flap losses and 2 partial flap losses. Minor complications occurred in 38 cases (40.9%). Patients aged 60 years or above were at significant higher risk of major complications (p = 0.029). Use of fasciocutaneous flaps (odds ratio [OR]: 14.341; p = 0.005), arterial hypertension (OR: 18.801; p = 0.014), and operative time (min) (OR: 1.010; p = 0.029) were identified as individual risk factors for major complications. Two venous anastomoses significantly reduced the risk of major complications (OR: 0.078; p = 0.022). Multiresistant bacterial wound colonization (OR: 65.152; p < 0.001) and defect size (OR: 1.007; p = 0.045) were identified as independent risk factors for minor complications. The median hospital stay was 28 days (7–85 days). Age significantly correlated with the length of hospital stay (r = 0.405, p < 0.01).
Conclusion Our study identified independent risk factors that might help to make individual decisions whether to target microsurgical forefoot reconstruction or primary amputation. Two venous anastomoses should be performed whenever feasible, and muscle free flaps should be preferred in patients at higher risk of major surgical complications.