半筋膜瓣半皮瓣修复手足皮肤软组织缺损：单因素和Logistic多元回归分析

摘要

BACKGROUND:Transplantation of free anterolateral semi-fascial semi-flap is used clinicaly to repair soft tissue defects of the hand and foot, but the transplantation fails in some patients under the same conditions. OBJECTIVE:To observe a new method for repairing soft tissue defects of the hand and foot and to study the clinical effects. METHODS:Totaly 150 cases were subjected to transplantation of free semi-fascial semi-flap of the anterolateral thigh. The semi-flap was placed on the functional area of the hand or foot, and the semi-fascia was placed on the non-functional area. At 7-10 days after flap survival, semi-fascial granulation remodeling was carried out, and skin graft was used to cover the wound. Then, the factors influencing the success of flap transplantation were subjected to univariate and multivariate logistic regression analysis. RESULTS AND CONCLUSION:Free semi-fascial semi-flap transplantation had obvious therapeutic effects, and only one case appeared to have complete necrosis. Age and smoking history were found to be factors influencing the success of free semi-fascial semi-flap transplantation. In the successful transplantation group, the number of cases younger than 60 years old and without a history of smoking was significantly higher than that in the transplantation failure group. After 5 years of folow-up, only one patient was not satisfied with the therapeutic effects, and two cases had no fuly recovery in the functional areas. The results confirm that free semi-fascial semi-flap repair of hand-foot soft tissue defects can achieve good postoperative results, and the main factors that influence the success of the surgery are age and smoking history.%背景：临床中采用游离的股前外侧半筋膜瓣半皮瓣移植修复手足软组织缺损，有部分患者在修复过程相同的情况下移植失败。　　目的：观察手足软组织缺损的一种新型的修复方法以及考察临床效果。　　方法：纳入150例患者应用游离的股前外侧半筋膜瓣半皮瓣移植，半皮瓣置于手或足部的功能区，半筋膜瓣置于非功能区，成活后7-10 d行半筋膜瓣肉芽重塑，植皮覆盖创面。而后对影响游离半筋膜瓣半皮瓣修复成功的因素进行单因素和Logistic多元回归分析。　　结果与结论：游离半筋膜瓣半皮瓣对患者的治疗效果明显，仅有1例患者存在完全坏死。分析筛选出患者年龄、吸烟史2个影响游离半筋膜瓣半皮瓣移植成功的因素，结果在移植成功组中年龄低于60岁和无吸烟史的病例数显著的高于移植失败者。经过5年的随访，仅有1例患者对移植后效果不感到满意，2例患者日常行动功能未有完全恢复。结果证实，采用游离半筋膜瓣半皮瓣移植修复手足皮肤软组织缺损可以收到很好的修复后效果，而影响该修复成功的主要因素为患者的年龄和有无吸烟史。