拇手指再造的多组织移植术后血管危象探讨  

Vascular crisis after multiple tissue transplantation for thumb and other finger reconstruction by toe-to-hand transfer

作　　者：张健[1] 黄剑[1] 潘佳栋[1] 周丹亚[1] 尹善青[1] 李俊杰[1] 王欣[1] 

机构地区：[1]宁波市第六医院手外科,浙江宁波315040

出　　处：《中国修复重建外科杂志》2017年第3期323-326,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：宁波市江东区科技局基金项目(2015A610312)~~

摘　　要：目的通过回顾多个游离组织再造拇手指并修复足部供区的患者资料,探讨术后血管危象发生的原因及有效处理方法,提高移植组织成活率。方法 2012年2月—2015年10月,收治59例拇手指缺损患者。男46例,女13例;年龄18~42岁,平均30.6岁。采用不同形式的与?甲瓣同一血管蒂的复合组织瓣移植再造拇手指并修复皮肤缺损,同时用穿支皮瓣修复供区,共涉及197个游离组织。术后17例21个游离组织(10.7%)(再造指或皮瓣)发生血管危象,其中动脉危象8例9个游离组织(4.6%),静脉危象10例12个游离组织(6.1%)。首先均行保守治疗;7例8个游离组织因保守治疗无效,行术中探查发现4例5个游离组织吻合口栓塞,1例1个游离组织血管蒂扭曲,1例1个游离组织血肿压迫,1例1个游离组织吻合口栓塞合并血肿压迫,予以清理血肿、切除栓塞血管、调节血管张力、重新吻合或血管移植处理。结果动脉危象患者中,5例5个游离组织经保守治疗后症状缓解,全部成活;3例4个游离组织行手术探查者,其中1个发生部分坏死。静脉危象患者中,6例8个游离组织经保守治疗后1个发生坏死,1个发生部分坏死;4例4个游离组织行手术探查,其中1个部分坏死。4个发生坏死部位,2个行再次皮瓣修复,2个行植皮修复,均成活。结论多个游离组织移植再造拇手指术后血管危象情况复杂,一旦发现危象应及时处理,可获得较高成活率。Objective To explore the causes of vascular crisis after thumb and other finger reconstruction by toe-to-hand transfer and effective treatment methods so as to improve the survival rate of transplanted tissues. Methods Between February 2012 and October 2015, 59 cases of thumb and other finger defects were repaired with different hallux nail flaps with the same vascular pedide flap to reconstruct thumb and other fingers and repair skin defect. The donor site was repaired by a perforator flap. A total of 197 free tissues were involved. There were 46 males and 13 females with the average age of 30.6 years （range, 18-42 years）. Vascular crisis occurred in 21 free tissues （10.7%） of 17 patients, including 9 arterial crisis （4.6%） of 8 cases, and 12 venous crisis （6.1%） of 10 cases. Conservative treatment was performed first; in 8 free tissues of 7 cases after failure of conservative treatment, anastomotic thrombosis was found in 5 free tissues of 4 cases, twisted vascular pedicle in 1 free tissue of I case, surrounding hematoma in 1 free tissue of I case, and anastomotic thrombosis associated with hematoma in 1 free tissue of 1 case, which underwent clearing hematoma, resecting embolization, regulating vascular tension, re-anastomosis or vascular transplantation. Results In 8 cases of arterial crisis, 5 free tissues of 5 cases survived after conservative treatment; partial necrosis occurred in 1 free tissue （1 case） of 4 free tissues （3 cases） undergoing surgical exploration. In 10 cases of venous crisis, I free tissue necrosis and 1 free tissue partial necrosis occurred in 8 free tissues （6 cases） undergoing conservative treatment; partial necrosis occurred in I free tissue of 4 free tissues （4 cases） undergoing surgical exploration. Free flap and skin graft were performed on 2 free tissues of 4 cases having flap necrosis respectively, Conclusion Vascular crisis is complex and harmful to survivalof transplanted tissue in reconstruction of the thumb and other fingers. Immediate interven

关 键 词：拇手指再造 游离组织移植 血管危象 

分 类 号：R658.1[医药卫生—外科学]