小腿受区血管缺乏时重建梯的研究  

Reconstructive ladder of the leg without sufficient recipient vessels

作　　者：朱跃良[1] 殷作明[2] 范新宇[1] 何晓清[1] 徐永清[1] 

机构地区：[1]成都军区昆明总医院骨科,昆明650032 [2]西藏军区总医院

出　　处：《中华显微外科杂志》2017年第4期328-332,共5页Chinese Journal of Microsurgery

基　　金：成都军区医学科学技术研究计划项目（B14012）

摘　　要：目的通过病例分析和文献总结，制定一个小腿受区血管缺乏时行游离皮瓣转移覆盖创面的重建梯．方法2009年1月至2015年1月．进行游离皮瓣覆盖小腿手术中发现小腿受区血管吻合有困难者129例，患者男113例，女16例，年龄4～71岁．平均36．5岁，其中创伤性创面108例，非创伤性创面21例。应对措施包括延长切口（25例），血管移植（22例），Flow—through吻合（17例），端侧吻合（13例）．邻近血管吻合（18例），创面远端吻合（14例）．桥式吻合（7例），和放弃手术（13例）。结果除手术中放弃游离皮瓣13例外（10．1％）．129例中86例愈合皮瓣完全成活（66．7％），9例皮瓣出现全坏死（7．0％）．皮瓣边缘坏死11例（8．5％）。根据由易到难的原则．制定了应对措施的重建梯。结论小腿受区血管缺乏为多因素所致．应当综合考虑．按重建梯的原则由易到难．选用最佳方案。Objective To establish the reconstructive ladder for the leg without sufficient recipient vessels by case analysis and literature review. Methods From January, 2009 to January, 2015, 772 cases were treated in our center using free flap for leg coverage and 129 cases were found intra-operatively to have insufficient recipient vessels. There were 113 males and 16 females , and the age ranged from 4 to 71 years, averaging 36.5 years. The wounds were post-traumatic （n=108） and non post-traumatic （n=21）. The management methods included elongating incision （n=25）, vessel transfer（n=22）, Flow-through anastomosis （n=17）, end-to-side anastomosis （n=13）, useing neighbor- ing vessels （n=18）, anastomosis distal to the injured zone （n=14）, cross-leg free flap （n=7）, and abandoning free flap transfer（n=13）. Results Except for the cases of abandoning surgery （n=13, 10.1%）, there were 86 cases whose flap healed totally （66.7%）, 9 cases total lost（7.0% ）, and 11 cases marginal loss （8.5%）. It established a reconstructive ladder for this special situation according to the principle of difficulty level. Conclusion The insufficient recipient vessels of the leg were had multi-causes which should be taken account generally before surgery. The optimal protocol for each case should be chosen from the reconstructive ladder based on the technical difficulty level.

关 键 词：穿支皮瓣 游离皮瓣 受区血管 小腿 显微吻合 

分 类 号：R658.3[医药卫生—外科学]