传统皮瓣与穿支皮瓣的临床回顾对比研究  

A retrospective study of the application of traditional flaps and perforator flaps

作　　者：王剑利[1] 刘兴龙[1] 赵刚[1] 张龙[2] 

机构地区：[1]解放军第89医院全军创伤骨科研究所,潍坊261021 [2]潍坊医学院,山东261053

出　　处：《中国骨与关节杂志》2015年第2期128-132,共5页Chinese Journal of Bone and Joint

摘　　要：目的通过对传统游离皮瓣与穿支皮瓣病例的回顾性研究,探讨两种皮瓣、手术风险、成活率及术后功能存在的共性和差异,试图找出预防、解决方法。方法通过对2000年至2010年,1320例游离皮瓣、肌皮瓣及穿支皮瓣病案资料回顾性研究,随机抽取300例,（180例传统皮瓣、120例穿支皮瓣）进行随访研究。随访1.5～5年。从皮瓣选择、设计、切取、移植、供受区的处理以及修复后功能等几个方面进行对比,找寻存在的问题和缺陷,逐项分析原因,并根据临床经验和教训,提出预防、应对的措施和方法。结果300例皮瓣,因故放弃和失败10例,成功率为96.7%,术后皮瓣坏死率为3.3%。术中发生血管危象38例,其中传统皮瓣16例,穿支皮瓣22例,传统皮瓣经对症处理解除危象27例,手术挽救成功1例;穿支皮瓣对症处理解除危象19例,1例失败放弃,2例穿支皮瓣部分坏死。完全失败10例。本组急诊皮瓣手术32例,感染率仅为3.2%。慢性创面268例,感染率为8.58%,慢性创面感染率远高于急诊创面。其它还有：边缘愈合不良及部分坏死、皮瓣与受区匹配问题、供区遗留创面、瘢痕,功能障碍等问题。结论预防和及时处理血管危象是保障皮瓣成活的关健。严格遵守皮瓣切取原则,控制好修饰性切取适应证,注意皮瓣张力是皮瓣手术的技术要求。手术供区正确封闭处理方式,是预防、解决并发症及功能不良的有效方法。Objective To explore the similarities and differences in the application method, operation procedure, risk, survival rate and postoperative functional recovery between traditional free flaps and perforator flaps based on a retrospective study, and to propose preventive measures and solutions through an analysis of the existing problems. Methods The clinical data of 1320 cases of free flaps, musculocutaneous flaps and perforator flaps from 2000 to 2010 were retrospectively studied, from which 300 cases were randomly sampled. Among them, there were 180 cases of traditional flaps and 120 cases of perforator flaps. A follow-up study was performed, and the followup period ranged from 1.5 years to 5 years. A comparison was made in the aspects of flap selection, design, incision and transplantation, treatment of donor and recipient sites and function after restoration. The existing problems and defects were found out, and the causes were analyzed. The preventive measures and solutions were proposed based on the clinical experience and lessions. Results Among the 300 cases, 10 cases were given up or failed for any reason. The success rate was 96.7%, and the postoperative flap necrosis rate was 3.3%. Vascular crisis was found in 38 c ases, including 16 cases of traditional flaps and 22 cases of perforator flaps. The crisis in 27 cases of traditional flaps was relived after symptomatic treatment, and 1 patient was successfully saved by surgery. The crisis in 19 cases of perforator flaps was relieved, and 1 case was given up. Partial necrosis was noticed in 2 cases, and 10 cases completely failed. The flap operation was performed on 32 patients in the emergency room, and the infection rate was only 3.2%. There were 268 patients with chronic wounds, and the infection rate was 8.58%. The infection rate of chronic wounds was much higher than that of the wounds treated in the emergency room. There were other problems such as poor healing of the wound edge, partial necrosis, matching of flaps and recipient sites, left wounds and

关 键 词：外科皮瓣 软组织损伤 传统皮瓣 游离皮瓣 创伤和损伤 

分 类 号：R658[医药卫生—外科学]