皮瓣内穿支血管对游离动脉化静脉皮瓣微循环影响的临床对比研究  

Clinical comparative study of the perforator vessel in flap for improving the microcirculation of free forearm arterialized venous skin flap

作　　者：白印伟[1] 张振伟[1] 李征[1] 余少校[1] 熊懿[1] 吴文溢 曾锦浩[1] 

机构地区：[1]广州医科大学附属深圳沙井医院手外科,广州深圳518104

出　　处：《实用手外科杂志》2015年第2期154-157,178,共5页Journal of Practical Hand Surgery

摘　　要：目的 对比研究在使用游离动脉化静脉皮瓣修复手部皮肤缺损时,围绕穿支血管切取皮瓣对皮瓣术后微循环的影响.方法 2008年12月—2013年4月,应用游离的前臂掌侧动脉化静脉皮瓣修复手部皮肤缺损共50例,其中常规切取29例（A组）,围绕尺/桡动脉穿支血管并结合浅静脉走行设计并切取皮瓣21例（B组）,分别于术后即刻、第1,2,3天及术后2周对皮瓣的皮色、皮温、返流速度及肿胀程度等指标进行观察.结果 A组：完全成活26例,部分成活2例,坏死1例.B组：21例皮瓣全部成活.术后随访10-18个月,平均12.5个月,两组皮瓣均质地柔软,略显臃肿,轻度色素沉着,两点辨别觉A组：8-10 mm,平均9 mm,B组：7-9 mm,平均8 mm. 结论 将穿支血管较为完整地保留于游离动脉化静脉皮瓣内,术后早期可在一定程度上改善因动脉血大量逆向灌注导致的组织水肿,但对于因静脉回流障碍所致的皮瓣水肿无明显改善.Objective To comparativly study the effectiveness that if the perforator vessel could improve microcirculation of flap with the forearm free arterialized venous flaps in repairing soft tissue defect of the hand. Methods Between December 2008 and April 2013, total 50 cases of soft tissue defects of the hand were treated. Team A （ 29 cases）, team B （21 cases）. Observe the colour, temperature, regurgitation speed, swelling degree of flap at immediately, the first/second/third day after operation. Results Team A：26 flaps survived, 2 flaps partly survived and 1flap necrosis. Team B： all flaps survived. The patients were followed up 10 months to 18 months （mean 12.5 months）. The flaps had soft texture, slightly bulky appearance, and deeper color than normal skin. The two-point discrimination was 7-9 mm （mean 8 mm）. Conclusion The perforator can improve the arterial perfusion of flap in early postoperation, but has a limited role to reduce venous disorders.

关 键 词：穿支血管 动脉化静脉皮瓣 微循环 

分 类 号：R622.1[医药卫生—整形外科]