Effects of anterolateral femoral free flap transplantation on the repair of soft tissue defect of hands and feet and risk factors for flap necrosis.

[OBJECTIVE] To retrospectively analyze the effect of anterolateral femoral free flap transplantation in repairing hand and foot soft tissue defects and the risk factors for skin flap necrosis.

[METHODS] The clinical data of 62 patients with hand and foot soft tissue defects admitted to Department of Hand and Foot Microsurgery in Yuyao People's Hospital of Zhejiang Province from January 2018 to December 2021 were retrospectively analyzed. According to the different methods of skin flap transplantation, these patients were divided into a control group (n=30, conventional skin flap transplantation) and an observation group (n=32, anterolateral femoral free skin flap transplantation). The clinical outcomes and postoperative flap survival rate were compared between the two groups. The risk factors of flap necrosis were analyzed by univariate and multivariate Logistic regression.

[RESULTS] The surgical time, intraoperative blood loss and hospital stay in the observation group were significantly less than those in the control group (all P<0.05). The survival rate of skin flap in the observation group was significantly higher than in the control group (P<0.05). Logistic regression analysis showed that intraoperatively incomplete hemostasis, inappropriate selection of anastomotic vessels, irrational use of antibiotics, infection and unstable fixation were independent risk factors for skin flap necrosis following hand and foot soft tissue defects surgery.

[CONCLUSION] Anterolateral femoral free flap transplantation is beneficial to improve the clinical outcomes in patients with hand or foot soft tissue defects, increase the survival rate of skin flap and promote recovery. Incomplete hemostasis during operation, inappropriate choice of anastomotic vessels, irrational application of antibiotics, concurrent infection and unstable fixation are independent risk factors for postoperative flap necrosis.