经皮缝扎阻断小隐静脉回流降低远端蒂腓肠神经营养血管皮瓣静脉瘀血的临床研究  

Effect of blocking the lesser saphenous vein by percutaneous suturing on the distally based sural neurocutaneous flap

作　　者：查选平 周赤龙 金钟鸣 张彩明 李焱 

机构地区：[1]解放军第422医院烧伤整形美容外科,湛江524009

出　　处：《中华损伤与修复杂志（电子版）》2009年第3期16-19,共4页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探讨经皮缝扎小隐静脉干及其大部分属支以阻断静脉回流对减轻远端蒂腓肠神经营养血管皮瓣瘀血的优越性。方法对40例应用远端蒂腓肠神经营养血管皮瓣的患者,按入院时间顺序分成2组。A组在外踝尖水平以下1cm处将小隐静脉干分离并结扎。B组以外踝尖与跟腱水平连线的中点为圆点,半径为2cm的在外踝尖水平以下的半圆周上用1号丝线经皮交叉缝扎(深度至深筋膜层下)以阻断小隐静脉干及其大部分属支的静脉回流。对两组处理蒂部小隐静脉的耗时和皮瓣发生坏死情况进行观察、比较。结果B组处理蒂部小隐静脉的耗时(平均1.52min)明显少于A组(平均10.57min)差异有统计学意义;B组有1例皮瓣不完全坏死(发生率为5%),A组有4例皮瓣不完全坏死(发生率为20%),但两组的差异无统计学意义。结论在远端蒂腓肠神经营养血管皮瓣蒂的远端经皮缝扎小隐静脉干及其大部分属支减轻静脉血倒灌的效果确切,而且操作更简单、更省时。Objective To explore the superiority of blocking the lesser saphenous vein trunk and its more than half branches by percutaneous suturing on the distally based sural neurocutaneous flap. Methods Forty cases of distally based sural neurocutaneous flaps were assigned to ：2 groups according to the time of admission. In group A the lesser saphenous vein trunk was separated and ligated at 1cm distal to the tip of the external ankle. In group B the lesser saphenous vein trunk and its more than half branches were blocked by percutaneous suturing with 1# silk thread at the lower half circle, the centre of which was at the middle between the external ankle and achilles tendon, and the radius was 2 cm. The time consumed to blocking the lesser saphenous vein and the necrosis of flaps were observed. Results The time consumed to blocking the lesser saphenous vein in groups B（1.52 min on average）was significantly shorter than that in group A （ 10.57 min average） . There was only 1 case with partial necrosis in group B, howerver 4 cases in group A. But the difference of flap necrosis rate between group A and B was not significant. Conclusions Blocking the lesser saphenous vein trunk and its more than half branches with percutaneous suturing can effectively decrease the venous drainage of the distal pedicle sural neurocutaneous flap. The method of percutaneous suturing is simpler than separating and ligating, which may save operating time evidently.

关 键 词：移植 皮瓣 腓肠神经 小隐静脉 静脉回流 

分 类 号：R658.3[医药卫生—外科学] R739.96[医药卫生—临床医学]