吻合浅静脉的穿支螺旋桨皮瓣的临床应用  

Clinical application of perforator propeller flaps with anastomosis of superficial veins

作　　者：李涛[1] 陈振兵[1] 丛晓斌[1] 艾方兴[1] 周攀[1] 洪光祥[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院手外科,武汉430022

出　　处：《中华整形外科杂志》2015年第2期107-110,共4页Chinese Journal of Plastic Surgery

基　　金：湖北省自然科学基金（2013CFC040）

摘　　要：目的 探讨通过吻合皮瓣浅静脉改善穿支螺旋桨皮瓣静脉回流的临床效果.方法 2011年9月至2012年12月,对收治的11例四肢皮肤软组织缺损和慢性溃疡创面,采用邻近穿支螺旋桨皮瓣转移修复,其中腓动脉穿支皮瓣5例,外踝上穿支皮瓣3例,尺动脉腕上穿支皮瓣2例,骨间后侧穿支皮瓣1例;创面大小3.0 cm ×2.5 cm～11.0 cm×4.0 cm,皮瓣面积6 cm×3 cm～ 21 cm×5 cm,术中均将皮瓣远端的1支浅静脉与受区皮下浅静脉吻合.术后观察皮瓣血运、评价肿胀度,1～3个月行彩色超声检查静脉吻合口的通畅情况,6～12个月问卷调查患者对皮瓣外形满意度.结果 术后9例皮瓣完全存活,伤口一期愈合,2例皮瓣远端各有长2.5、3.0 cm的皮肤坏死,经换药后伤口均在2个月内愈合,9例获得12～ 19个月随访,皮瓣外形美观,质地良好,所有患者对皮瓣外形满意度均较高.皮瓣平均存活面积为（98.6±9.7）％;皮瓣早期肿胀程度：Ⅰ度0例,Ⅱ度8例,Ⅲ度3例,Ⅳ度0例;皮瓣后期肿胀程度：Ⅰ度7例,Ⅱ度4例,Ⅲ度0例,Ⅳ度0例.结论 吻合浅静脉的穿支螺旋桨皮瓣,可以减轻皮瓣的静脉回流阻力,有利于皮瓣的存活,是一种有效改善皮瓣静脉问题的超引流方法.Objective To investigate the clinical effect of anastomosis of superficial veins for improving the drainage of perforator propeller flaps.Methods From Sept.2011 to Dec.2012,11 cases with soft tissue defects and chronic ulcer wound at extremities were treated with adjacent perforator propeller flaps,which were pedicled by the peroneal artery（5 cases）,or the lateral supramalleolar artery（3 cases）,or the ulnar artery（2 cases）,or the posterior interrosseous artery （1 case）.The wound size ranged from from 3.0 cm × 2.5 cm to 11.0 cm × 4.0 cm,and the falps size ranged from 6 cm× 3 cm to 21 cm × 5 cm.One superficial vein in all the flaps was anastomosed with superficial vein in the recipient area.The blood supply of the flaps were recorded after operation 1-3 months after operation,the fluency of anastomosed vein was detected by color Doppler ultrasound.Flap swelling evaluations were performed in early 3 months and later 3-6 months,and the results were classified into 4 grading degrees.6 months later,Questionnaire of the flap aesthetic satisfactory was performed for seven patients during follow-up period.Results 9 flaps survived completely,two flaps had partial marginal skin necrosis in the distal end,which were both managed with surgical debridement,and both wounds healed in two months.9 cases were followed up for more than 12-19 months.The early rsults of flap swelling evaluations were：Ⅰ degree 0 case,Ⅱ degree 8 cases,Ⅲ degree 3 cases,Ⅳ degree 0 case,and the later results were：Ⅰ degree 7 cases,Ⅱ degree 4 cases,Ⅱ degree 0 case,Ⅳ degree 0 case.The flaps had ideal appearance,good contour,and high aesthetic satisfactory （100%）.The mean flap survival area rate of veins auastomosed was （98.6 ±9.7） %.Conclusions Perforator propeller flaps with anastomosis of superficial veins can improve the flap venous drainage,avoid transient venous venous congestion,so as to increase the flap survival.It is an effective way for improving the vein drainage.

关 键 词：外科皮瓣 穿支皮瓣 显微外科手术 静脉 

分 类 号：R622[医药卫生—整形外科]