吻合浅静脉的逆行皮神经营养血管皮瓣的应用  

THE CLINICAL APPLICATION OF DISTALLY BASED NEUROCUTANEOUS FLAPS BY ANASTOMOSIS OF SUPERFICIAL VEINS

作　　者：柴益民[1] 林崇正[1] 陈汉东[1] 张燕翔[1] 陈彦堃[1] 

机构地区：[1]海南省人民医院显微外科,海口570311

出　　处：《中国修复重建外科杂志》2001年第4期217-218,共2页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：海南省科技厅基金资助项目 (9845;)

摘　　要：目的　探讨吻合浅静脉的皮神经营养血管逆行皮瓣临床应用的效果。方法　 1996年 6月起对19例肢体远端皮肤缺损采用皮神经营养血管逆行皮瓣移位修复 ,其中皮肤创伤性缺损 10例 ,慢性溃疡 3例 ,瘢痕挛缩 6例。采用腓肠神经营养血管皮瓣 9例 ,隐神经营养血管皮瓣 2例 ,前臂内侧皮神经营养血管皮瓣 5例 ,前臂外侧皮神经营养血管皮瓣 3例。术中将皮瓣远端的浅静脉与受区皮下静脉作端端吻合以改善静脉回流。皮瓣范围15 cm× 2 4cm～ 4cm× 6 cm ,血管蒂长 6～ 15 cm。结果　 17例皮瓣完全成活 ,1例前臂内侧皮神经皮瓣修复手掌创面及 1例腓肠神经皮瓣修复足内侧瘢痕创面 ,术后因吻合的静脉栓塞致皮瓣远端部分坏死。 16例获得 6～ 2 4个月随访 ,皮瓣质地优良 ,恢复保护性感觉 ,外形及功能改善满意。结论　吻合浅静脉可以明显改善该类皮瓣的静脉回流 。Objective To investigate the clinical results of the distally based neurocutaneous flap by anastomosis of superficial veins. Methods From June 1996, 19 cases with composite skin defects of the distal part of limb were repaired by the transposition of distally based neurocutaneous flaps, including traumatic defect in 10 cases, chronic ulcer in 3 cases, scar contracture in 6 cases. The distally based sural neurocutaneous flaps were used in 9 cases,the reverse flow saphenous neurocutaneous island flaps were used in 2 cases, and the retrograde neurocutaneous island flaps of the forearm were used in 8 cases. The flap area ranged from 15×24 cm to 4 ×6 cm, the pedicle of the flap ranged from 6 cm to 15 cm in length. The superficial vein of the flap were anastomosed with the subcutaneous superficial vein of the recipient site to improve the venous drainage. Results The composite flap survived completely in 17 cases. One cases with retrograde flow forearm neurocutaneous flap and another case with reversed sural neurocutaneous flap were partially survived because of thrombosis in anastomosed veins postoperatively. Sixteen cases were followed up for 6 to 24 months, the color and texture of the flap were excellent, the protective sensation were recovered, the configuration and function were satisfactory. Conclusion Anastomosis of superficial veins of the composite flaps with the subcutaneous superficial veins of the recipient site can significantly improve the venous drainage, enlarge the survival area of the flap and the reparable area.

关 键 词：浅静脉 逆行皮瓣 皮神经营养血管皮瓣 吻合浅静脉 

分 类 号：R622.1[医药卫生—整形外科]