To explore the related factors with skin flap necrosis, we concluded the cases of patients with skin defects after free flap plantation.

From 2001 to 2016, 188 cases about 20 influencing factors were analyzed (The characteristics of patients: age, sex, smoke, diabetes, high blood pressure; Preoperative factors: injured sections, injured causes, preoperative wound infection, preoperative wound osteomyelitis, the time from injury to operation; Intraoperative factors: operator, operation time, anesthesia time, intraoperative rehydration fluids, the way of vascular anastomosis, the number of venous anastomosis, the area of flap; Postoperative factors: flap hematoma, flap infection, vascular crisis) and multivariate logistic regression analysis was used to analyze the relationship between these risk factors and flap necrosis.

All 188 cases were treated with free anterolateral thigh flap to repair soft tissue defect and it was revealed that the 174 cases were successful (92.55%) and 23 cases were occured vascular crisis (12.23%), 8 cases were arterial crisis, 11 cases were vein crisis, 4 cases were ateriovenous crisis. After the treatment, the rescue was successful in 5 cases (38.46%). After the analysis we made the conclusion that the number of venous anastomoses, flap hematoma and vascular crisis were related with the skin flap necrosis.

The number of venous anastomose (≥2) will increase blood return to make the flap easier to survive. Intraoperative stanching and drainage tube placement work will reduce the skin flap hematoma as a result of reducing the skin flap necrosis. Artery and venous crisis handled in time, can enhance the survival rate of flap.

Femoral anterolateral flap; Vascular crisis; Necrosis; Regression analysis