Objective:To investigate the clinical effect of free superficial iliac circumflex artery perforator flap with different arterial anastomosis methods for repairing soft tissue defects of limbs.Methods:A retrospective cohort study was used to analyze the data of 60 patients with soft tissue defects of limbs treated in Ningbo No.6 Hospital from March 2017 to March 2020, including 38 males and 22 females, aged 21-57 years［(35.6±3.1)years］. The wounds were located on the upper limb in 33 patients and the lower limb wound in 27 patients. The defect area was 4.5 cm × 2.0 cm-17.0 cm × 8.0 cm. All patients received debridement and vacuum sealing drainage (VSD) in stage I, and free superficial iliac circumflex artery perforator flap transplantation in stage II. The flap area was 4.9 cm × 2.6 cm-17.0 cm × 8.0 cm. According to the different anastomotic vessels, the superficial iliac circumflex artery was anastomosed end-to- side to the radial artery in 25 patients, the ulnar artery in 8, the dorsalis pedis artery in 18 and the anterior tibial artery in 9. Flap healing and healing time were detected. Texture and appearance of the flap were observed at the last follow-up. The appearance of the donor area was evaluated by Vancouver scar scale (VSS), and the satisfaction rate of appearance of the recipient area was measured by numerical score.Results:All patients were followed up for 5-15 months［(7.1±1.3)points］. All flaps survived successfully after operation, including arterial crisis in 4 patients, among which 2 had flap perforator anastomosed with the radial artery, 1 with the ulnar artery and 1 with the dorsalis pedis artery. There was no significant difference in flap crisis after end-to-side arterial anastomosis in different recipient areas ( P>0.05). For patients with flap perforator anastomosed with the radial artery, the ulnar artery, the dorsalis pedis artery and the anterior tibial artery, the flap healing time was 15(14, 16)days, 15(14, 16)days, 14.5(14，16)days and 14(14，15.5)days, respectively (all P>0.05). The flaps showed sufficient elasticity and soft texture at the last follow-up. For patients with flap perforator anastomosed with the radial artery, the ulnar artery, the dorsalis pedis artery and the anterior tibial artery, the VSS of the donor area was (10.2±1.5)points, (10.9±1.6)points, (9.4±1.5)points and (9.8±1.5)points at the last follow-up (all P>0.05), and the satisfaction rate of appearance of the recipient area was 9 (8, 10)points, 9(8, 9)points, 9(8, 9)points and 8(8, 9.5)points at the last follow-up ( P>0.05), showing that all patients were satisfied with the appearance of the wound. Conclusions:The transplantation of free superficial iliac circumflex artery perforator flap with different arterial anastomosis methods is safe and reliable in repairing soft tissue defects of limbs with advantages of low occurrence of postoperative vascular crisis, good flap survival, no influence on flap healing by different anastomotic vessels, hidden donor area with small scar and satisfactory appearance of the recipient area. It can be used as one of the common vascular repair methods for free tissue flap transplantation.

Objective:To explore forecast indicators for the prognosis of sepsis in adult extremely severe burn patients.Methods:Case data of adults with extremely severe burns combined with sepsis admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to December 2021 were retrospectively collected. According to the prognosis, all patients were divided into a death group and a survival group. The general conditions of the two groups were compared. The clinical symptoms, vital signs, platelet count (PLT), white blood cell count (WBC), neutrophil ratio, procalcitonin (PCT), blood sodium, blood glucose, hemoglobin and albumin levels at diagnosis of sepsis were also compared between the two groups. The independent sample t test, Mann?Whitney U test, or Fisher's exact probability test was used for group comparison. Variables with statistical significance in univariate analysis were included in the Cox regression model for multivariate analysis to assess the effect of each index on the outcome of extremely severe burn patients with sepsis. The predictive value of each index for sepsis outcome was analyzed by the receiver operating characteristic curve (ROC). Results:A total of 60 patients with particularly severe burn sepsis were selected, including 41 males and 19 females aged 18 to 84 years. The diagnosis time of sepsis was 14 (7, 24) days after injury. There were 29 patients in the death group and 31 patients in the survival group, and the mortality rate was 48.3%. Compared with the survival group, PLT and hemoglobin levels in the death group decreased significantly (both P<0.05), and PCT and blood sodium levels increased significantly (both P<0.05), while the other indicators did not change significantly (all P>0.05). The results of multivariate Cox regression analysis showed that hemoglobin ( HR=0.936, 95% CI: 0.935-0.991) and serum sodium levels ( HR=1.031, 95% CI: 1.010-1.052) at the time of sepsis diagnosis were independent risk factors affecting the prognosis of sepsis in extra-severe burn patients (both P<0.05). ROC curve analysis showed that the AUCs of hemoglobin, blood sodium and PCT for predicting the prognosis of extremely severe burn patients with sepsis were 0.747, 0.811 and 0.690, respectively (all P<0.05). The cut-off value of hemoglobin for predicting prognosis was 77 g/L, with a sensitivity of 69.0% and specificity of 74.2%. The cut-off value of blood sodium for predicting prognosis was 138 mmol/L, with a sensitivity of 89.7% and specificity of 61.3%. The cut-off value of PCT was 3.51 μg/L, with a sensitivity of 65.5% and specificity of 74.2%. Conclusions:Hemoglobin, blood sodium and PCT may be predictors of outcome in extremely severe burn patients with sepsis.