隐神经营养血管蒂逆行岛状皮瓣坏死原因分析  

Causes of reversed-flow neurocutaneous saphenous flap necrosis in surgical reconstruction of distal legs

作　　者：马春旭[1] 宁方刚[1] 王慧英[1] 

机构地区：[1]北京积水潭医院烧伤科,100035

出　　处：《北京医学》2013年第10期838-840,共3页Beijing Medical Journal

摘　　要：目的探讨逆行隐神经皮瓣修复术后出现皮瓣坏死的原因。方法回顾性分析2009年1月至2012年1月251例行逆行隐神经皮瓣修复手术患者的临床资料。结果术后共出现皮瓣部分坏死31例,30例原因明确,其中蒂部损伤13例(43.3%),合并症导致肢体远端循环障13例(43.3%),皮瓣下血肿2例(6.7%),皮瓣受压1例(3.3%),高龄患者外周血管条件差1例(3.3%);原因不明1例。结论术前未能发现的蒂部损伤以及各种合并症和高龄导致的肢体远端血运障碍是逆行隐神经皮瓣坏死的主要原因。术中操作和术后护理不当也是隐神经营养血管蒂逆行岛状皮瓣修复小腿远端创面失败的原因之一。Objective To study the factors associated with flap necrosis in surgical reconstruction of distal leg using reversed-flow neurocutaneous saphenous island flaps.Methods The data of 251 clinical cases who underwent reversed-flow neurocutaneous saphenous island flaps reconstruction from January 2009 to January 2012 were retrospectively analyzed.Thirty-one cases of flap necrosis were observed.The medical records,including pre-operational examination,operational records,and clinical outcomes were analyzed to determine the possible causes of flap necrosis.Results Thir ty-one flap necrosis occurred after operation in all 251 cases.The cause for necrosis in 1 patient was unclarified,the causes of the rest included 13 cases（43.3%） for pre-operational trauma in the pedicle flap,13 cases（43.3%） for hypertensive and（or） diabetic complications which affected circulation of the distal legs,2 cases（6.7%） for hematoma caused by post-operative bleeding,1 case（3.3%） for ischemia caused by external pressure to the flap,and 1 case（3.3%） with old age for poor circulation around the flap.Conclusion The unnoticed pre-surgery flap damage,impaired distal circulation due to complications and advanced age are the major determinants for reversed-flow neurocutaneous saphenous island flap necrosis.Inappropriate procedure during the operation and poor post-operational care also contribute to unsuccessful reconstruction surgery of the distal legs.

关 键 词：隐神经 岛状皮瓣 坏死 

分 类 号：R622[医药卫生—整形外科]