多个端侧吻合口吻合方式在游离股前外侧穿支皮瓣移植中的应用  

The application of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation

作　　者：马振杰[1] 于胜军[1] 李晓[1] 李京宁[1] 季远[1] 姜俊杰[1] 窦洪磊[2] Ma Zhenjie;Yu Shengjun;Li Xiao;Li Jingning;Ji Yuan;Jiang Junjie;Dou Honglei(Department of Hand Surgery, Yantaishan Hospital, Yantai, Shandong Province 264001, China;Department of Hand and Foot Surgery, Yidu Central Hospital of Weifang, Weifang, Shandong Province 262500, China)

机构地区：[1]烟台市烟台山医院手外科,264001 [2]潍坊市益都中心医院手足外科,262500

出　　处：《中华显微外科杂志》2019年第1期9-12,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨多个端侧吻合口吻合方式在游离股前外侧穿支皮瓣移植手术中的应用效果。方法2013年1月至2017年10月,应用受区同一血管的多个端侧吻合口吻合方式进行股前外侧穿支皮瓣移植修复创面29例,其中皮瓣动脉均端侧吻合于受区同一动脉15例,吻合动脉2~3条,平均2.13条,皮瓣静脉均端侧吻合于受区同一静脉9例,吻合静脉2~4条,平均3.11条,皮瓣动、静脉均端侧吻合于受区同一动脉及静脉5例,吻合血管4~6条,平均5.20条。创面分布:手部及腕部10例,前臂及肘关节15例,小腿及足部4例。软组织缺损面积5 cm×13 cm^11 cm×27 cm,皮瓣切取面积6 cm ×15 cm^12 cm × 29 cm。术后每3~6个月门诊随诊,复查皮瓣成活情况。结果本组移植29例皮瓣术后全部成活,2例术后48 h内出现静脉危象,其中1例松解敷料,拆除部分缝线后皮瓣成活,1例手术探查,静脉端侧吻合口通畅,血肿形成,去除血肿压迫后循环恢复,皮瓣成活。术后随访6个月~2.5年,皮瓣受区与供区均愈合良好,损伤肢体远端无血运障碍表现。结论应用受区同一血管的多个端侧吻合口吻合方式进行股前外侧穿支皮瓣的游离移植安全可靠。Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation. Methods From January, 2013 to October, 2017, 29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair. Fifteen cases treated with multiple end-to-side anastomosis on flap arteries, and 2-3 arteries were anastomosed, with the average of 2.13. Nine cases were treated with venous multiple end-to-side anastomosis, and 2-4 veins were anastomosed, with the average of 3.11. Five cases treated with arterial and venous multiple end-to-side anastomosis, and 4-6 vessels were anastomosed, with the average of 5.20. Distribution of wounds: 10 cases with hands and wrists wounded, 15 cases with forearms and elbow joints wounded, and 4 cases with lower legs and feet wounded. The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm, and the flap area was 6 cm×15 cm-12 cm×29 cm. Postoperative followed-up was performed every 3-6 months to review flap survival. Results All flaps of 29 cases survived. Venous congestion occurred in 2 flaps within 48 h after the operation, among which, 1 was overcomed after released the dressing and sutures, and the other underwent surgical exploration. The venous end-to-side anastomotic stomas were unobstructed, and hematoma was formed. After the hematoma compression was removed, circulation was recovered and the flap survived. With followed-up for 6 months to 2.5 years, both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder. Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable.

关 键 词：股前外侧穿支皮瓣 血管吻合 端侧吻合 修复 显微外科技术 

分 类 号：R658[医药卫生—外科学]