Intraoperative blood perfusion factors in free anterolateral thigh flap repair for diabetic foot ulcers: A retrospective analysis

Table 1 Demographic and clinical characteristics of patients by perfusion status, n (%)

Parameters	Normal blood perfusion (n = 50)	Abnormal blood perfusion (n = 50)	t/χ2	P value
Age (years)	50.47 ± 8.64	55.29 ± 8.12	2.88	< 0.01
BMI (kg/m²)	23.44 ± 3.82	25.96 ± 4.17	3.15	< 0.01
Education level (years)	9.39 ± 3.67	8.62 ± 3.84	1.02	0.31
Gender			0.05	0.83
Male	33 (66.00)	34 (68.00)
Female	17 (34.00)	16 (32.00)
Employment, work for pay	22 (44.00)	20 (40.00)	0.16	0.69
Residential status			0.18	0.67
Rural	15 (30.00)	17 (34.00)
Urban	35 (70.00)	33 (66.00)
Marital status			0.27	0.87
Married	41 (82.00)	39 (78.00)
Single	6 (12.00)	7 (14.00)
Divorced	3 (6.00)	4 (8.00)
Smoking history	16 (32.00)	18 (36.00)	0.18	0.67
Drinking history	13 (26.00)	15 (30.00)	0.20	0.66
Hypertension	24 (48.00)	28 (56.00)	0.64	0.42
Cardiovascular disease	9 (18.00)	14 (28.00)	1.41	0.24
DR	16 (32.00)	20 (40.00)	0.69	0.41
DPN	13 (26.00)	25 (50.00)	6.11	0.01
DN	11 (22.00)	16 (32.00)	1.27	0.26
Affected toes			1.07	0.30
Yes	16 (32.00)	21 (42.00)
No	34 (68.00)	29 (58.00)
Walking impairment			1.21	0.27
Yes	12 (24.00)	17 (34.00)
No	38 (76.00)	33 (66.00)
Results of wound specimen bacterial culture			0.93	0.33
Positive	9 (18.00)	13 (26.00)
Negative	41 (82.00)	37 (74.00)
Wagner grade			0.64	0.42
3	26 (52.00)	22 (44.00)
4	24 (48.00)	28 (56.00)
Foot ulcer size (cm²)	12.39 ± 4.67	13.48 ± 5.12	1.11	0.27
Duration of diabetes (years)	10.18 ± 3.88	12.91 ± 4.09	3.43	< 0.01

DR: Diabetes retinopathy; DNP: Diabetes peripheral neuropathy; DN: Diabetes nephropathy; BMI: Body mass index.

Table 2 Preoperative vascular status and metabolic control evaluation of the two groups of patients, n (%)

Parameters	Normal blood perfusion (n = 50)	Abnormal blood perfusion (n = 50)	t/χ2	P value
Ankle-brachial index			7.29	< 0.01
Poor	5 (10.00)	16 (32.00)
Good	45 (90.00)	34 (68.00)
MAP (mmHg)	89.10 ± 10.43	86.79 ± 11.28	1.06	0.29
Glycated hemoglobin HbA1c (%)	7.39 ± 1.62	8.44 ± 1.43	3.44	< 0.01
Blood glucose (mmol/L)	7.83 ± 2.17	8.45 ± 2.13	1.44	0.15

Ankle-brachial index < 0.3 was defined as poor, Ankle-brachial index ≥ 0.3 was defined as good. HbA1c: Glycated hemoglobin; MAP: Mean arterial pressure.

Table 3 Preoperative baseline hematological differences between the two groups of patients

Parameters	Normal blood perfusion (n = 50)	Abnormal blood perfusion (n = 50)	t	P value
RBC (1012/L)	4.76 ± 0.48	4.57 ± 0.51	1.89	0.06
WBC (109/L)	6.67 ± 1.83	7.31 ± 1.96	1.68	0.10
NEUT (109/L)	4.16 ± 1.34	4.25 ± 1.41	0.31	0.75
LYM (109/L)	1.99 ± 0.54	1.91 ± 0.57	0.70	0.49
EOS (109/L)	0.24 ± 0.11	0.23 ± 0.12	0.73	0.47
BASO (109/L)	0.09 ± 0.03	0.09 ± 0.03	0.43	0.67
Hb (g/L)	135.83 ± 12.47	128.15 ± 13.12	3.00	< 0.01
PLT (109/L)	241.68 ± 58.74	224.92 ± 62.37	1.38	0.17
MON (109/L)	0.53 ± 0.18	0.51 ± 0.19	0.58	0.56

RBC: Red blood cell count; WBC: White blood cell count; NEUT: Neutrophil count; LYM: Lymphocyte; EOS: Eosinophil count; BASO: Basophil count; Hb: Hemoglobin; PLT: Platelet count; MON: Monocyte.

Table 4 Subgroup analysis of hemoglobin levels and intraoperative blood perfusion status by gender

Parameters	Normal blood perfusion (n = 50)	Abnormal blood perfusion (n = 50)	t	P value
Male	33	34
Hemoglobin (g/L)	143.11 ± 11.25	134.74 ± 12.01	2.94	< 0.01
Female	17	16
Hemoglobin (g/L)	122.72 ± 9.87	117.67 ± 10.23	1.44	0.16

Table 5 Preoperative nutritional status differences between groups

Parameters	Normal blood perfusion (n = 50)	Abnormal blood perfusion (n = 50)	t	P value
Prealbumin (mg/L)	253.03 ± 45.62	227.88 ± 51.47	2.59	0.01
Total cholesterol (mmol/L)	4.87 ± 0.89	4.66 ± 0.94	1.16	0.25
LDL (mmol/L)	2.91 ± 0.74	2.82 ± 0.79	0.62	0.54
HDL (mmol/L)	1.24 ± 0.32	1.21 ± 0.34	0.42	0.68
Triglycerides (mmol/L)	1.60 ± 0.53	1.91 ± 0.61	2.77	< 0.01

LDL: Low-density lipoprotein cholesterol concentration; HDL: High-density lipoprotein cholesterol concentration.

Table 6 Univariate logistic regression analysis of factors affecting intraoperative blood perfusion in free anterolateral thigh perforator flap repair for diabetic foot ulcers in patients with type 2 diabetes

Parameters	Coefficient	Std Error	Wald	P value	OR (95%CI)
Age (years)	0.07	0.03	2.69	< 0.01	1.07 (1.02-1.13)
BMI (kg/m²)	0.16	0.06	2.91	< 0.01	1.17 (1.06-1.31)
DPN [n (%)]	1.05	0.43	2.44	0.02	2.85 (1.25-6.75)
Duration of diabetes (years)	0.18	0.06	3.10	< 0.01	1.19 (1.07-1.34)
Ankle-brachial index (poor)	1.44	0.56	2.58	0.01	4.24 (1.50-14.00)
Glycated hemoglobin HbA1c (%)	0.45	0.14	3.15	< 0.01	1.57 (1.20-2.11)
Hb (g/L)	-0.05	0.02	-2.80	< 0.01	0.95 (0.92-0.99)
PaO2 (kPa)	-0.48	0.15	-3.16	< 0.01	0.61 (0.45-0.82)
PaCO2 (kPa)	1.47	0.47	3.13	< 0.01	4.34 (1.82-11.59)
Albumin (g/L)	-0.13	0.05	-2.43	0.02	0.88 (0.79-0.97)
Creatinine (μmol/L)	0.03	0.01	2.56	0.01	1.03 (1.01-1.06)
Prealbumin (mg/L)	-0.01	< 0.01	-2.45	0.01	0.99 (0.98-1.00)
Triglycerides (mmol/L)	0.98	0.38	2.61	< 0.01	2.68 (1.31-5.82)

PaO₂: Pulse oxygen partial pressure; PaCO₂: Arterial blood partial pressure of carbon dioxide; DNP: Diabetes peripheral neuropathy; BMI: Body mass index; HbA1c: Glycated hemoglobin; Hb: Hemoglobin; OR: Odds ratio.

Table 7 Multivariate logistic regression analysis of factors affecting intraoperative blood perfusion in free anterolateral thigh perforator flap repair for diabetic foot ulcers in patients with type 2 diabetes

Parameters	Coefficient	Std Error	Wald	P value	OR (95%CI)
Age (years)	0.09	0.05	1.85	0.07	1.09 (1.00-1.20)
BMI (kg/m²)	0.27	0.11	2.39	0.02	1.31 (1.05-1.64)
DPN [n (%)]	1.80	0.98	1.84	0.07	6.03 (0.89-41.06)
Duration of diabetes (years)	0.27	0.11	2.47	0.01	1.31 (1.06-1.63)
Ankle-brachial index (poor)	0.36	1.20	0.30	0.77	1.43 (0.14-14.85)
Glycated hemoglobin HbA1c (%)	0.31	0.10	3.07	< 0.01	1.37 (1.12-1.67)
Hb (g/L)	-0.13	0.04	-2.97	< 0.01	0.88 (0.81-0.96)
PaO2 (kPa)	-1.10	0.38	-2.87	< 0.01	0.33 (0.16-0.71)
PaCO2 (kPa)	1.04	0.31	3.41	< 0.01	2.84 (1.56-5.17)
Albumin (g/L)	-0.10	0.04	-2.59	0.01	0.91 (0.85-0.98)
Creatinine (μmol/L)	0.12	0.04	3.08	< 0.01	1.13 (1.04-1.22)
Prealbumin (mg/L)	-0.03	0.01	-2.81	< 0.01	0.97 (0.95-0.99)
Triglycerides (mmol/L)	1.14	0.82	1.39	0.17	3.11 (0.62-15.53)

PaO₂: Pulse oxygen partial pressure; PaCO₂: Arterial blood partial pressure of carbon dioxide; DNP: Diabetes peripheral neuropathy; BMI: Body mass index; HbA1c: Glycated hemoglobin; Hb: Hemoglobin; OR: Odds ratio.