Comparison of Anterolateral Thigh Perforator and Peroneal Artery Perforator Flaps in Elderly Patients With Foot Soft Tissue Defects.

IF 0.9 4区医学 Q3 SURGERY

Annali italiani di chirurgia Pub Date : 2025-07-10 DOI:10.62713/aic.4048

Jingjing Hu, Fei Wang, Jiang Li, Liqi Yi, Jiguo Yang

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引用次数: 0

Abstract

Aim: This study aimed to explore the efficacy of anterolateral thigh perforator (ALTP) flap and peroneal artery perforator (PAP) flap transplantation and their influence on levels of pain and wound growth factors in elderly patients with soft tissue defects caused by foot trauma.

Methods: A total of 98 elderly patients with foot trauma who underwent flap transplantation in the hospital from January 2022 to January 2024 were collected and analyzed retrospectively. Patients were divided into the ALTP group (n = 45, receiving ALTP flap transplantation) and the PAP group (n = 53, receiving PAP flap transplantation). Visual analogue scale (VAS) and American orthopedic foot and ankle society (AOFAS) score were used to assess the pain and functional outcome. Enzyme-linked immunosorbent assay (ELISA) kits were utilized to test the levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and hypoxia inducible factor 1 (HIF-1) in wound fluid.

Results: The wound size in the ALTP group was larger than that in the PAP group (p < 0.001). Longer operative time, hospitalization time and greater intraoperative blood loss were noted in the ALTP group than in the PAP group (p < 0.001). Linear regression analysis showed that the surgical method was the main factor affecting operative time, hospitalization time and intraoperative blood loss (p < 0.001). The necrosis rate in the ALTP group (13.33%) was higher than that in the PAP group (3.77%), but the difference was not statistically significant (p = 0.176). Compared with the ALTP group, the VAS score of the PAP group was markedly reduced at 3 days and 1 week after surgery, and 1 month after follow-up (p < 0.001). 3 days after surgery, the levels of VEGF and bFGF of the PAP group were significantly increased compared with the ALTP group (p < 0.001). 1 week after surgery, the levels of bFGF of the PAP group were higher compared with the ALTP group (p = 0.003). The total incidence rate of complications in the ALTP group (25/44, 56.82%) was significantly higher than that in the PAP group (7/53, 13.21%) (p < 0.001). And multivariate logistic regression analysis showed that ALTP was the independent influencing factors for complications (p < 0.001). At 6 months after surgery, there was no significant difference in AOFAS scores between the two groups (p = 0.078).

Conclusions: ALTP and PAP flap transplantation were both suitable for the reconstruction of soft tissue defects caused by foot trauma in elderly patients, with the latter associated with shorter surgical time and hospitalization time, as well as better wound healing, less postoperative pain and fewer complications.

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股前外侧穿支皮瓣与腓动脉穿支皮瓣治疗老年足部软组织缺损的比较。

目的：探讨股前外侧穿支（ALTP）皮瓣和腓动脉穿支（PAP）皮瓣移植对老年足部软组织缺损患者疼痛和创面生长因子水平的影响。方法：回顾性分析2022年1月~ 2024年1月在我院行足部皮瓣移植的老年外伤患者98例。患者分为ALTP组（n = 45，接受ALTP皮瓣移植）和PAP组（n = 53，接受PAP皮瓣移植）。采用视觉模拟量表（VAS）和美国骨科足踝学会（AOFAS）评分来评估疼痛和功能结局。采用酶联免疫吸附试验（ELISA）试剂盒检测创面液中血管内皮生长因子（VEGF）、碱性成纤维细胞生长因子（bFGF）和缺氧诱导因子1 （HIF-1）的水平。结果：ALTP组创面面积明显大于PAP组（p < 0.001）。与PAP组相比，ALTP组手术时间更长，住院时间更长，术中出血量较大（p < 0.001）。线性回归分析显示，手术方式是影响手术时间、住院时间和术中出血量的主要因素（p < 0.001）。ALTP组坏死率（13.33%）高于PAP组（3.77%），但差异无统计学意义（p = 0.176）。与ALTP组比较，PAP组术后3天、1周及随访1个月VAS评分均显著降低（p < 0.001）。术后3 d， PAP组VEGF、bFGF水平较ALTP组显著升高（p < 0.001）。术后1周，PAP组bFGF水平高于ALTP组（p = 0.003）。ALTP组总并发症发生率（25/44,56.82%）显著高于PAP组（7/53,13.21%）（p < 0.001）。多因素logistic回归分析显示ALTP是并发症的独立影响因素（p < 0.001）。术后6个月，两组患者AOFAS评分比较，差异无统计学意义（p = 0.078）。结论：ALTP和PAP皮瓣移植均适用于老年足部外伤软组织缺损的重建，前者手术时间和住院时间较短，且创面愈合较好，术后疼痛少，并发症少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annali italiani di chirurgia 医学-外科

CiteScore

0.90

自引率

12.50%

发文量

116

审稿时长

>12 weeks

期刊介绍： Annali Italiani di Chirurgia is a bimonthly journal and covers all aspects of surgery:elective, emergency and experimental surgery, as well as problems involving technology, teaching, organization and forensic medicine. The articles are published in Italian or English, though English is preferred because it facilitates the international diffusion of the journal (v.Guidelines for Authors and Norme per gli Autori). The articles published are divided into three main sections:editorials, original articles, and case reports and innovations.