Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis

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The skin of the hand not only protects major neurovascular bundles, tendons and bone from damage, but it also has a unique function. The thick volar skin can provide protection and fine sensation, bear shear forces and remain stable to touch, whereas the thin and pliable dorsal skin maintains mobility and allows a wide range of motion of the finger and wrist.1 Therefore, the reconstruction of complex soft tissue defects caused by trauma, thermal injuries, tumour resection or infection poses a serious challenge to surgeons.
Currently, the pedicled flap remains a mainstay in hand soft tissue defect reconstruction2 due to the reconstructive principle of ‘like‐with‐like’. However, partial or total flap necrosis remains the main complication and has a relatively high incidence.17 Most studies regarding risk factors of flap necrosis have focused on the risk factors of pedicled flaps of the lower extremities and free flaps.18 Gir et al. found that age, gender, aetiology or location of the defect, and type or size of the flap were not statistically significant risk factors associated with complications of pedicled perforator flaps in the lower extremities,24 whereas Bekara et al. found that age older than 60 years, diabetes and arteriopathy are significant risk factors for perforator‐pedicled flap complications in the lower extremities.21 In addition, de Blacam et al. stated that venous insufficiency and increasing age were both risk factors for pedicled flap complications.20 Furthermore, Las et al. reported that diabetes, prolonged anaesthesia time and postoperative wound infection were risk factors for free flap failure.19 Sanati‐Mehrizy et al. concluded that smoking and operative time were risk factors for free flap necrosis.27 In addition, previous studies have demonstrated that the rotary arc (<180°) of a pedicled flap and the timing of reconstruction of soft tissue defects have no significant effect on perioperative complications.18 To date, few studies have reported the total necrotic rate of various pedicled flaps and the risk factors for flap necrosis in hand soft tissue defect reconstruction.
The purpose of this study was to assess the non‐technical factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis.
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