目的 探讨四肢皮肤软组织缺损患者游离皮瓣移植术后皮瓣坏死的影响因素。方法 纳入2021年3月至2023年12月于北京积水潭医院接受游离皮瓣移植术治疗的180例四肢皮肤软组织缺损患者进行分析,依据术后皮瓣成活情况分为成活组（n=158）与坏死组（n=22）。比较患者临床资料,采用单因素和多因素Logistic回归分析四肢皮肤软组织缺损患者游离皮瓣移植术后皮瓣坏死的影响因素。结果 单因素分析结果显示,成活组与坏死组在性别、吸烟史、血管危象、体质量指数（body mass index,BMI）以及手术时间上的比较,差异均具有统计学意义;多因素回归分析显示,有吸烟史,发生血管危象、BMI偏高均为四肢皮肤软组织缺损患者游离皮瓣移植术后皮瓣坏死的独立危险因素。联合预测拟合方程的曲线下面积（area under curve,AUC）为0.773（95%CI：0.671~0.875）;校准曲线显示,预测模型的预测值与实际值之间具备良好一致性,平均绝对值误差为0.033;Hosmer-Lemeshow拟合优度检验表明,该预测模型具有较好的校准度（χ2=794,P=0.531）。结论 四肢皮肤软组织缺损患者游离皮瓣移植术后皮瓣坏死可能与吸烟史、血管危象、BMI偏高等因素相关。
Abstract
Objective To investigate the influencing factors of flap necrosis in patients with skin and soft tissue defects after free flap transplantation. Methods A total of 180 patients with skin and soft tissue defects of limbs who received free skin flap transplantation in Beijing Jishuitan Hospital from March 2021 to December 2023 were enrolled and analyzed. According to postoperative survival of skin flap, they were divided into survival group (n=158) and necrosis group (n=22). The clinical data and laboratory indexes of patients were compared. Single and multiple Logistic regression were used to analyze the influencing factors of flap necrosis in patients with skin and soft tissue defects of limbs after free flap transplantation. Results Univariate analysis showed that there were significant differences in gender, smoking history, vascular crisis, body mass index (BMI) and operation time between the surviving group and the necrotic group (all P<0.05). Multivariate regression analysis showed that smoking history, vascular crisis and high BMI were independent risk factors for flap necrosis in patients with skin and soft tissue defects of limbs after free flap transplantation (all P<0.05). The area under the curve (AUC) of the combined prediction was 0.773(95%CI 0.671~0.875). The calibration curve shows that there is a good agreement between the predicted value and the actual value, and the average absolute error is 0.033. Hosmer-Lemeshow goodness of fit test showed that the prediction model had a good calibration degree (χ2=794, P=0.531). Conclusion The necrosis of skin flap after free skin flap transplantation in patients with soft tissue defect of extremities may be related to smoking history, vascular crisis, high BMI.
关键词
影响因素 /
皮肤软组织缺损 /
皮瓣坏死 /
游离皮瓣移植术
Key words
influencing factors /
skin soft tissue defect /
flap necrosis /
free flap grafting
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基金
北京市医院管理中心“登峰”计划专项经费（DFL20240402）; 首都医科大学附属北京积水潭医院护理科研基金立项（HL202406）
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