Clinical application and influencing factors of free flap transplantation for the reconstruction of skin and soft tissue defects: A retrospective cohort study

Skin and soft tissue defects, often caused by trauma, infection, burns, or surgery, can significantly impair function and quality of life. Free flap transplantation is a key technique for reconstructing such defects, but its success is influenced by multiple factors. This study aimed to evaluate clinical outcomes and identify critical factors affecting flap survival. A retrospective cohort of 120 patients treated with free flap transplantation from January 2019 to December 2023 was analyzed. Patients were categorized into a survival group (n = 106) and a necrosis group (n = 14) based on flap viability. We examined preoperative, intraoperative, and postoperative variables, including demographics, comorbidities, surgical duration, vessel anastomosis methods, and complications. Results showed that multiple venous anastomoses significantly improved flap survival (P = .012), while vascular crises (P = .005) and hematoma formation (P = .031) increased the risk of flap necrosis. Multivariate analysis confirmed these as independent factors. In conclusion, free flap transplantation is effective for soft tissue defect reconstruction. Increasing venous anastomoses and promptly managing vascular crises and hematomas are essential strategies to improve outcomes. These findings may guide clinical optimization of flap transplantation procedures.