游离组织瓣移植血供障碍原因分析与防治对策(附305例报告)  

Etiology and management of vascular compromise of free flap transplantation:a report with 305 cases

作　　者：任志勇[1] 杜玲[1] 黄现峰[1] 王辉[1] 魏长月[1] 李永江[1] 张维彬[1] 

机构地区：[1]解放军第89医院全军创伤骨科研究所,山东潍坊261021

出　　处：《解放军医学杂志》2007年第10期1075-1076,共2页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨游离组织移植血供障碍的原因和防治对策。方法回顾性分析1983年6月-2006年12月游离组织瓣移植手术血循环障碍病例305例，根据组织瓣类型和修复部位的不同，从手术设计、切取组织瓣、血管变异、切取技术、手术时机、血管搭配、血管清创、血管张力、血管吻合、血管危象处理和感染等11个方面研究组织瓣血供障碍的原因。结果本组305例中动脉供血不良270例。组织瓣切取后动脉供血不良10例，其中组织瓣营养血管损伤6例，修复损伤的血管后皮瓣成活，其余4例组织瓣动脉供血不足，组织瓣移植后远端坏死，切除坏死的组织瓣，采用局部旋转皮瓣和游离植皮覆盖创面。其余260例经血管探查，成活213例，坏死47例。静脉回流障碍35例，成活5例，部分坏死10例，坏死20例。结论游离组织瓣移植发生血循环障碍是导致组织瓣坏死的主要原因。临床上根据引起血循环障碍的原因，有针对性地采取措施，可有效地防止组织瓣坏死。静脉回流障碍是组织瓣失败的主要因素。Objective To investigate the causer of, and the way to deal with the measurement of protecting from vascular compromise in free flap transplantation,Methods To retrospectively study the clinical data collected from the 89th Hospital of PLA including 305 cases of vascular compromise in free flap transplantation held on June, 1983 to December, 2006. Accoding to the different tissue flaps and different sites to be repaired, 11 factors of vascular compromise of free flap transplantation were to be investigated including operation design, the recipe of free flap, the variation of vascellum, the skill of recipe, the operation opportunity, the match of vascellum, the debride of vascellum, the vascellum angiotasis, the vascular anastomosis, the management of vascular articulo and the infection. Results Among the 305 cases of free flap transplantation, arterial compromise existed in 270 cases, 10 cases developed arterial compromise during operation, 6 cases were due to the injury of nutrient vessel, the flap survived after the revascularization. 4 cases obtained part necrosis of 10 cases, and the rotation flap and skingrafting covered the raw surface. The rest 213 cases survived and 47 cased failed. Another 35 cases of vein compromise were obtained. Among them, 5 cases survived, part necrosis of 10 cases, and 20 cases failed. Conclusion Vascular compromise is the factor of necrosis in free flap transplantation. It is of cardinal importance to timely and correctly treat the vascular compromise in free flap transplantation whether happened intra-or postoperatively. This is the key to access high successful rate. Preventive measures are even more beneficial than proper management after its occurrence. The venous return disorder was the main factor of free flap transplantation failure.

关 键 词：外科皮瓣 组织移植 血管危象 

分 类 号：R622.13[医药卫生—整形外科]