Plast Reconstr Surg. 2022 Sep 1. doi: 10.1097/PRS.0000000000009646. Online ahead of print.
ABSTRACT
BACKGROUND: Despite remarkable improvements in free flap procedures, partial flap losses in perforator flap still occur. This study aimed to analyze partial necrosis cases which underwent reconstruction of the lower extremities using anterolateral thigh (ALT) free flaps and identifies risk factors causing the occurrence of partial necrosis.
METHODS: From January 2005 to February 2017, 303 ALT free flaps were retrospectively analyzed. After collecting patient’s data, receiver operating characteristic (ROC) curve was conducted to find the critical distance between the perforator and the flap margin which distinguishes incidence of partial necrosis. Also, the rate of partial losses was calculated for each section after dividing the distance from the perforator to the flap margin into 1cm sections. Lastly, logistic regression analyses were performed to identify the risk factors.
RESULTS: 43 cases had partial flap losses (14.19%). Flaps with supra-deep fat layer elevation showed the highest rate of partial necrosis (25.53 %) with statistical significance (p = 0.0001). In ROC curve, the cut-off distance was 10.25 cm. In addition, flap tissues 8 cm away from the perforator have a 10.3 % chance of necrosis, whereas those 12 cm away from the perforator have a 22.9 % chance. Lastly, supra-deep fat layer elevation (OR: 3.952) and large flap dimension (OR: 1.041) were risk factors of partial flap necrosis on multivariate analysis.
CONCLUSIONS: The distance from perforator to flap margin, flap elevation layer, and flap dimension affected the occurrence of partial necrosis. Taking these into consideration, ALT free flap of appropriate size and thickness should be harvested.
PMID:36067478 | DOI:10.1097/PRS.0000000000009646
