A retrospective study of the application of traditional lfaps and perforator lfaps

WANG Jian-li; LIU Xing-long; ZHAO Gang; ZHANG Long

doi:10.3969/j.issn.2095-252X.2015.02.18

Abstract：Objective To explore the similarities and differences in the application method, operation procedure, risk, survival rate and postoperative functional recovery between traditional free lfaps and perforator lfaps based on a retrospective study, and to propose preventive measures and solutions through an analysis of the existing problems. Methods The clinical data of 1320 cases of free lfaps, musculocutaneous lfaps and perforator lfaps from 2000 to 2010 were retrospectively studied, from which 300 cases were randomly sampled. Among them, there were 180 cases of traditional flaps and 120 cases of perforator flaps. A follow-up study was performed, and the follow-up period ranged from 1.5 years to 5 years. A comparison was made in the aspects of lfap selection, design, incision and transplantation, treatment of donor and recipient sites and function after restoration. The existing problems and defects were found out, and the causes were analyzed. The preventive measures and solutions were proposed based on the clinical experience and lessions. Results Among the 300 cases, 10 cases were given up or failed for any reason. The success rate was 96.7%, and the postoperative lfap necrosis rate was 3.3%. Vascular crisis was found in 38 cases, including 16 cases of traditional lfaps and 22 cases of perforator lfaps. The crisis in 27 cases of traditional lfaps was relived after symptomatic treatment, and 1 patient was successfully saved by surgery. The crisis in 19 cases of perforator lfaps was relieved, and 1 case was given up. Partial necrosis was noticed in 2 cases, and 10 cases completely failed. The lfap operation was performed on 32 patients in the emergency room, and the infection rate was only 3.2%. There were 268 patients with chronic wounds, and the infection rate was 8.58%. The infection rate of chronic wounds was much higher than that of the wounds treated in the emergency room. There were other problems such as poor healing of the wound edge, partial necrosis, matching of lfaps and recipient sites, left wounds and scars in donate sites and dysfunctions. Conclusions The key to ensure the survival of the lfap is to prevent and deal with vascular crisis timely. The principle of lfap incision should be strictly complied with, and the indications of modiifed incision should be controlled. The lfap tension should be paid great attention as the technical requirement in lfap surgery. The correct sealing treatment of donate sites is an effective method to prevent and resolve the complications and dysfunctions.