Multiple Factors Analysis Of Partial Necrosis Of Posterior Tibial Artery Perforating Branch Fasciocutaneous Flap With Distal Pedicle

Objective:To investigate the rotation point,the aspect ratio of the flap,the length to width ratio of the fascia,the total length of the flap(the sum of the length of the flap and the length of the fascia pedicle),and the skin of the distal pedicled posterior pedicled fascia pedicle flap.The effect of the total length of the valve and the width of the fascia pedicle on the distal necrosis of the distal pedicled posterior pedicled fascia flap.Methods:Retrospectively analysis the clinical cases,operative pictures and efficacy of 37 patients who had been operated with the reverse fascial pedicle flap of the perforating branches of the tibialis posterior artery.The average patient age was 40.6 years old(age range:6-68 years).There were 31 cases of skin and soft tissue defects of lower limbs caused by various kinds of trauma,and 6 cases caused by chronic ulcer.All the defects complicate with bone,joint and/or tendon and fascia exposure.The upper bound of the excision extension of the flap can be to the popliteal fossa horizontal lines,and the lower bound is the rotation point.The rotation point was located 8.23±4.07cm above the tip of the medial malleolus,the total length of the flap is 18.14±4.06cm,the flap length-width ratio ranged from 0.64 to 3.0,the fascial pedicle length-width ratio ranged from 1 to 3.2,and the ratio of the length of the flap to the width of the fascial pedicle ranged from 2.38 to 9.6.Patients were divided into three groups according to their age:group a?18 years old,18years old<group b<50 years old,group c?50 years old;According to the gender,there were two groups:female group and male group.According to the injury site,it was divided into three groups:leg group,ankle group,plantar and back group.According to the flap rotation point,two groups were divided:group d<8.0cm,group e?8.0cm;The total length of the flap was divided into 2 groups:group f<18.0cm,group g?18.0cm;The flaps were divided into 3 groups according to the length/width:group h<1.0,1.0?group I<2.0,group j?2.0;According to the length/width of fascia pedicle of the flap,two groups were divided:group k<2.0,group 1?2.0;According to the total length of the flap/fascia pedicle width,the flap was divided into two groups:group m<4.0,group n?4.0;After surgery,the flaps were divided into two groups according to the survival of the flaps:complete survival group and partial necrosis group(including distal partial necrosis and distal epidermal necrosis).Statistical software SPSS25.0 was used to process all the data.Univariate analysis were tested by x2 test.Finally,Logistic regression was used to analysis the effect of multi-factors on distal necrosis of the flap.Results:37 cases,no completely necrosis flap.25 cases(67.6%)in the completely survived flap group.There are 12 cases(32.4%)in the partial necrosis flap group,including 9 cases(24.3%)with the distal epidermal flap necrosis,3 cases(8.1%)in the partial flap necrosis.All 12 cases flaps completely healed after debridement and dressing change given in 9 cases and skin graft given in 3 cases.Patients were followed up ranged from 2 weeks to 3 months(mean follow-up was 3.6 weeks).All flaps recovered satisfactorily after surgery,with beautiful appearance,little trauma in the donor area,friction resistance in the recipient area,and no recurrence of infection ect.Univariate analysis indicaing:There was a statistical difference in the injury sites between the two groups(P<0.05),and the partial necrosis rate at the distal end of the plantar and back flaps was significantly higher than that at the calves and ankles.There were no significant differences in gender,age,flap rotation point,total length of flap(sum of flap length and fascial pedicle length),ratio of flap length to width,ratio of total length of flap to fascial pedicle length,etc.(P>0.05).Logistic regression analysis of multiple factors:There were no statistically significant differences in gender,age,defect site,flap rotation point,total length of flap(sum of flap length and fascia pedicle length),ratio of flap length to width,ratio of total length of flap to fascia pedicle length and other factors(P>0.05).Conclusion:(1)Through research and analysis,it was found that the defect site had a certain impact on the partial necrosis after the operation of the fascial pedicle flap of the distal tibial posterior artery perforator,especially on the plantar and back.(2)The effects of various factors,such as the rotation point of the flap,the total length of the flap(the sum of the length of the flap and the fascial pedicle),the ratio of the length to the width of the flap,the ratio of the length to the width of the fascial pedicle,and the ratio of the total length to the width of the fascial pedicle,on the necrosis of the distal part of the flap were not obvious.