跨区带蒂腓动脉穿支皮瓣局部并发症血流动力学相关原因分析  

Hemodynamic factors related to complications of trans pedicled peroneal perforator flap

作　　者：徐毅 王扬剑[1] 陈芝武 华祖广 唐茂林[3] 魏鹏[1] Xu Yi;Wang Yangjian;Chen Zhiwu;Hua Zuguang;Tang Maolin;Wei Peng(Department of Plastic Surgery,Ningbo First Hospital,Ningbo 315010,China;Medical College of Ningbo University,Ningbo 315211,China;Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]宁波市第一医院整形修复重建外科,315010 [2]宁波大学医学院,315211 [3]温州医科大学,325035

出　　处：《中华整形外科杂志》2019年第12期1221-1225,共5页Chinese Journal of Plastic Surgery

基　　金：宁波市自然科学基金(2015A610207,2019A610323)。

摘　　要：目的分析跨区设计带蒂腓动脉穿支皮瓣术后出现局部坏死的血流动力学相关原因及预防策略。方法回顾分析宁波市第一医院整形修复重建外科收治的17例术后出现并发症的下肢远端软组织缺损病例,男12例,女5例,年龄22~46岁,缺损面积:5.0 cm×11.0 cm^8.0 cm×14.0 cm。缺损部位:足踝部外侧。创面均存在骨质、肌腱外露。所有患者均设计并切取跨区的带蒂腓动脉穿支皮瓣进行修复。其中3例在术中显露穿支的过程中,为减少穿支扭转形成卡压进行了穿支周围软组织裸化的手术操作。结果术后3~5 d,12例皮瓣远端局部坏死,坏死均分布在跨越腓动脉供区以外,其中1例进行了穿支裸化操作,均于适度开放引流并定期换药后好转;3例蒂部以远术后逐渐肿胀、青紫,其中2例为穿支裸化病例,1周后出现远端皮缘坏死并黑痂样改变,早期切痂后深筋膜存活,无骨质外露,定期0.5%聚维酮碘湿敷换药后,内皮细胞爬行覆盖创面;2例出现术后肿胀,青紫范围较大,蒂部松解后改善欠佳,术后2周后大部分皮肤坏死并远端黑痂样改变,予二期游离皮片移植覆盖创面。随访3个月,所有病例均不需要再次皮瓣移植。结论设计带蒂腓动脉穿支皮瓣尽量做到穿支血管同轴同源、最多跨区范围在2个choke区以内;术中选择穿支蒂部裸化不保留伴行静脉,不携带小隐静脉,可能在一定程度减少跨区设计并发症。Objective To analyze the causes of local necrosis and hemodynamics after pedicle peroneal perforator flap and try to find out prevention strategies.Methods Retrospective 17 tissue defect cases admitted by Plastic and Reconstructive Surgery of Ningbo First Hospital,which treated by pedicle perforator flap with kinds of complications.3 of 17 were naked the perforators to reduce reverse pressure.Patients involved 12 male,5 female,ages from 22 to 46,with defected area from 5.0 cm×11.0 cm to 8.0 cm×14.0 cm,located in lateral ankle.Results 3 to 5 days postoperative 12 cases with distal local necrosis,all of which were designed interregional,one with performator naked,turned back after drainage and wound dressing,3 cases were gradually swelling and purple postoperative,two of them were perforator naked.1 weeks later,the distal skin of flap necrosis and were gradually turning black scab appeared.With scab cutting and fascia survived,no bony tissues exposure,after 0.5%povidone iodine wet dressing regularly,endothelial cells crawled to cover.2 cases with larger ranger of swelling and purple,not be better even pedicale releasing was conducted,2 weeks later most part of the flap necrosis and the distal turned black eschar.After debridement and skin grafting,wounds healed later.All patients were followed up for 3 months with no flap transplantation required.Conclusions Coaxial homology,within 2 choke vessel areas,perforator skeletonization,kick out the small saphenous vein,might be the ways to reduce the complication of the cross area designing trans pedicled peroneal perforator flap.

关 键 词：血流动力学 带蒂皮瓣 皮瓣设计 

分 类 号：R65[医药卫生—外科学]