低分子肝素对指动脉逆行岛状皮瓣静脉危象的预防  

The Prevention of Venous Crisis of the Reverse-flow Island Flap by Low-molecular-weight Heparin

作　　者：王欣[1] 张世民[1] 祝晓忠[1] 张英琪[1] 俞光荣[1] 

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《实用骨科杂志》2013年第5期411-413,I0001,共4页Journal of Practical Orthopaedics

基　　金：国家自然科学基金(81201411);上海市卫生局青年科研项目(20114y152)

摘　　要：目的探讨应用低分子肝素预防指动脉逆行岛状皮瓣静脉危象的发生,提高皮瓣存活质量。方法自2008年3月至2012年3月,应用指动脉逆行岛状皮瓣修复手指创面17人,共19指,皮瓣面积1.8cm×1.4cm～3.5cm×2.5cm,蒂长1.5cm～2.2cm。术后除常规处理外,皮下注射低分子肝素5 000IU,每日一次,共5d。术后观察皮瓣血液循环情况。结果皮瓣早期血液循环良好。皮瓣持续渗血时间及渗血量较多,在皮瓣外形成质软的凝血块,用药过程中皮瓣边缘不易形成黑色血痂,过程中均未出现静脉危象,所有皮瓣均存活且存活质量高。术后随访3周～6个月,皮瓣颜色和周围皮肤基本一致,质地较软,手指活动功能满意。结论皮下注射低分子肝素能延长逆行岛状皮瓣术后皮瓣渗血时间,减轻皮瓣早期静脉回流的负荷,有效预防皮瓣发生静脉危象,提高了皮瓣的存活质量。Objective To evaluate the effect of low-molecular-weight heparin in the reverse-flow island flap. Methods From Mar. 2008~Mar. 2012,17 patients（19 fingers） were treated with reverse-flow island flap of arterial digitalis for the soft tissue defection in fingers. The flap area was about 1.8 cm× 1.4 cm～3.5 cm × 2.5 cm. Vascular pedicle length was about 1.5 cm--2.2 cm. The low molecular-weight heparin was subcutaneous injected after opera tion,5 000 IU once a day,total 5 times. The objects were observed including flaps color,swelling and bleeding of the flap. Results All flaps had good vascularization and survived eventually. The bleeding time of the flaps were signifi- cantly longer,and no flap showed obvious venous crisis. Conclusion The application of low-molecular weight heparin can increase the quality of flap survival after subcutaneous injection through increasing bleeding of flaps to release ve- nous drainage load of the flaps.

关 键 词：外科皮瓣 逆行岛状皮瓣 低分子肝素 静脉危象 

分 类 号：R619[医药卫生—外科学]