| Objective:To compare the flap-viability-related complications and risk factors of distally based sural neurofasciocutaneous flaps in children and adults.Methods:The clinical data and pictures of 201 distally based sural neurofasciocutaneous flaps performed from April 2001 to March 2011 were reviewed and analyzed retrospectively. Patients aged from 3 to 78 years were involved in this study. Etiology of 201 defects included: trauma (n=165), soft tissue tumor (n=4), unstable scarring (n=9), chronic osteomyelitis with ulcer (n=11) or sinus (n=5), chronic ulcer with paraplegia (n=3), venous insufficiency (n=3) or peripheral arterial disease (n=1). All the defects were combined with exposure of the bones, joints, tendons, and/or internal fixation hardware. The flaps were harvested between the popliteal fossa crease and the pivot point which was located 4.0-19.0cm above the tip of the lateral malleolus. The adipofascial pedicles were 2.0-18.0cm in length, and 2.5-6.0cm in width; total length (length of adipofascial pedicle plus the length of skin island) was 10.0-30.0cm, and the width of the flap was 4.0-16.0cm, and length to width ratio was (2.5-7.14):1. The dimensions of the flap were 5.0cm×4.0cm-20.0cm×15.0cm. There were 53 patients in Children group (<14 years), and 148 patients in Adult group (≥14 years). According to the flap viability, the outcomes were classified into three types:no complication (complete survival), major complication (partial necrosis), and minor complication (including marginal necrosis, de-epithelialization and wound dehiscence). Posterior aspect of the lower leg was equally divided into 9 zones. The following possible risk factors associated with flap-viability-related complications were analyzed and compared between Children group and Adult group:patients factors (sex, etiology, regions of soft tissue defects), flap factors (position of top-edge, location of pivot point, length to width ratio, length and width of both the skin island and the adipofascial pedicle, and total length of the flap). All the data were statistically analyzed by SPSS 17.0 software.Results:Out of the 201 flaps,148 flaps were completely survived. Partial necrosis occurred in 25 (12.4%) flaps, of which remaining defects were covered successfully by changing dressings (n=1), skin grafting (n=12), secondary suture (n=4) or transferring other local flaps (n=5), and eliminated by amputation (n=3). Marginal necrosis developed in 16 flaps (8.0%), and residual defects were re-surfaced by changing dressings (n=11) or secondary suture (n=5). De-epithelialization presented in 8 flaps (4.5%), whose remanent defects were re-epithelialized spontaneously without further surgical treatment. Wound dehiscence occurred in 4 flaps (2.0%), and residual defects were re-epithelialized through secondary suture (n=4). Follow-up of all the patients was carried out, with a mean course of 6.2 months (ranged from 2 weeks to 72 months). The appearance of the flaps was satisfied without infection. The major complication (partial necrosis) rate and minor complication (including marginal necrosis and de-epithelialization and wound dehiscence) rate were 13.2% and 17.0% in Children group, and 12.2% and 12.8% in Adult group, respectively. Overall complication rate in Children group (30.2%) was significantly higher than that in Adult group (25.0%) (P>0.05). The overall complication rate of the flaps with the top-edge locating in the 8th or upper zones in both Children group (45.5%,15/33) and Adult group (32.6%,28/86) were significantly higher than those of the flaps with the top-edge locating in the 7th or lower zones in Children group (5%,1/20) and Adult group (14.5%,9/62) (P<0.05), respectively. In Children group, the overall complication rate of the flaps with a width of 8cm or more (42.4%,14/33) was significantly higher than that of the flaps with a width of less than 8cm (10%,2/20) (P<0.05). In Adult group, the overall complication rate of the flaps with a width of 10cm or more (34.5%,20/58) was significantly higher than that of the flaps with a width of less than 10cm (18.9%,17/90) (P<0.05). In Children group, the values (including the width of adipofascial pedicle, the length of skin island, and the width of skin island and the total length of the flap) of the flaps with complications were more than those of the survival flaps (P<0.05). In Adult group, the values of the total length of the flaps with complications were more than those of the survival flaps (P<0.05). Conclusions:(1) There are no significant differences between children and adults in complications (including major complication, minor complication and overall complication) of distally based sural neurofasciocutaneous flaps; (2) In both children and adults, the flap with top-edge locating in lower 7/9 of the lower leg is safe and reliable; (3) When skin-island width is 8cm or more in children and 10cm or more in adults, possibility of complication present in the flap will rise significantly. |
PDF Full Text Request