title: Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis.
abstract: OBJECTIVE
  The purpose of this study is to determine the correlation between non-technical risk factors and the perioperative flap survival rate and to evaluate the choice of skin flap for the reconstruction of foot and ankle.
  
  
  METHODS
  This was a clinical retrospective study. Nine variables were identified. The Kaplan-Meier method coupled with a log-rank test and a Cox regression model was used to predict the risk factors that influence the perioperative flap survival rate. The relationship between postoperative wound infection and risk factors was also analyzed using a logistic regression model.
  
  
  RESULTS
  The overall flap survival rate was 85.42%. The necrosis rates of free flaps and pedicled flaps were 5.26% and 20.69%, respectively. According to the Cox regression model, flap type (hazard ratio [HR] = 2.592; 95% confidence interval [CI] (1.606, 4.184); P < 0.001) and postoperative wound infection (HR = 0.266; 95% CI (0.134, 0.529); P < 0.001) were found to be statistically significant risk factors associated with flap necrosis. Based on the logistic regression model, preoperative wound bed inflammation (odds ratio [OR] = 11.371,95% CI (3.117, 41.478), P < 0.001) was a statistically significant risk factor for postoperative wound infection.
  
  
  CONCLUSIONS
  Flap type and postoperative wound infection were both independent risk factors influencing the flap survival rate in the foot and ankle. However, postoperative wound infection was a risk factor for the pedicled flap but not for the free flap. Microvascular anastomosis is a major cause of free flap necrosis. To reconstruct complex or wide soft tissue defects of the foot or ankle, free flaps are safer and more reliable than pedicled flaps and should thus be the primary choice.
authors.affiliation: Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China.
authors.forename: Xiucun
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China.
authors.forename: Jianli
authors.initials: J
authors.lastname: Cui
authors.affiliation: Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China.
authors.forename: Suraj
authors.initials: S
authors.lastname: Maharjan
authors.affiliation: Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China.
authors.forename: Laijin
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China.
authors.forename: Xu
authors.initials: X
authors.lastname: Gong
mesh_terms: D000842:Ankle / Q000601:surgery*; D005528:Foot / Q000601:surgery*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps