Abstract:  Objective    To summarize the influencing factors of free anterolateral thigh flap necrosis in our hospital, and to discuss and analyze the related influencing factors.   Methods   A total of 1260 free anterolateral femoral flaps operated in our hospital from June 2014 to June 2024 were collected, and 23 related influencing factors were analyzed, including patient characteristics, preoperative factors, intraoperative factors, postoperative factors. Univariate analysis and multivariate logistic regression analysis were performed on these influencing factors and the results of flap necrosis.   Results    1260 free anterolateral thigh flaps survived in 1167 cases (92.6%) and necrotic in 93 cases (7.4%). Statistical analysis showed that the number of venous anastomosis, flap infection, subflap hematoma, vascular crisis were closely related to the necrosis of the free anterolateral femoral flap.   Conclusions   Venous vascular anastomosis (≥2) can increase blood return and make the flap more viable, and thorough debridement, precise hemostasis and adequate drainage during surgery can reduce the occurrence of flap infection and hematoma, reduce flap necrosis, and timely detection and treatment of arteriovenous crisis after surgery can improve the survival rate of flap.

Key words: Free anterolateral thigh flap; ,  , Risk factor; ,  ,  Necrosis; ,  ,  Logistic regression analysis