Chapter 5 Table 5.6 Patient characteristics with flap complications. FC Age BMI Smoker Radiotherapy Chemotherapy FW (g) FWU (%) Ischemia (min) 1 M‐PFL 47 25 Yes Yes Yes 829 94 65 2 m‐PFL 59 30 No Yes Yes 1451 90 50 3 m‐PFL 32 25 No Yes Yes 600 99 32 4 M‐PFL 57 35 Yes Yes Yes 712 89 50 5 M‐PFL 57 25 Yes Yes Yes 1048 100 48 6 M‐PFL 50 25 Yes No Yes 919 88 66 7 M‐PFL 48 27 Yes Yes Yes 869 72 61 8 m‐PFL 46 26 No Yes Yes 1096 81 34 9 M‐PFL 46 30 Yes No Yes 1021 100 37 BMI=Body mass index (kg.m^2). Patients who required extra surgery for debridement or secondary closure were all smokers. Radiotherapy and chemotherapy were administered in all patients at least > 2 months before reconstruction. Figure 5.2 Laser Doppler flow of zone IV with flap on its pedicle. These blood‐flow measurements were performed with the flap still on its vascular pedicle but completely dissected after a 10‐minute acclimatization period. In zone I, risk factors were not found to influence blood flow significantly. In zone IV, a lower blood flow was measured in flaps weighing over 800 g compared with flaps weighing less than 800 g. Patients with FC demonstrated lower blood flow in zone IV; however, this was not significant (data not shown). Patients with M‐PFL had a significantly lower blood flow in zone IV compared with patients who had either no FC or M‐PFL (Figure 5.3; P=0.040). LDF in zone I after reperfusion revealed no differences in the possible risk factors studied. In zone IV, several differences were observed. The factors that were not significant on blood flow of zone IV following reperfusion were radiotherapy, chemotherapy, flap weight, percentage of original abdominal flap, and ischemia time. Older patients (>55 years) showed higher blood flow in zone IV during the initial 5 hours after reperfusion compared with younger patients (Figure 5.4; P=0.008). No differences in LDF were observed in zone IV when comparing smokers to nonsmokers using the repeated‐measures ANOVA. However, analysis with the Mann‐Whitney U test 78
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