端侧吻合技术在个性化游离腹股沟皮瓣移植中的应用  

Application of end-to-side anastomosis in personalised free ilioinguinal flap transfer

作　　者：杨科跃[1] 黄剑[1] 陈川 孙赫阳 李一[1] 李学渊[1] 陈宏[1] 王欣[1] 戚建武[1] YANG Keyue;HUANG Jian;CHEN Chuan;SUN Heyang;LI Yi;LI Xueyuan;CHEN Hong;WANG Xin;QI Jianwu(Department of Hand Surgery,The Ningbo N0.6 Hospital,Ningbo,Zhejiang Province 315040,China)

机构地区：[1]宁波市第六医院手外科,浙江宁波315040

出　　处：《中华显微外科杂志》2021年第4期403-407,共5页Chinese Journal of Microsurgery

基　　金：宁波市鄞州区科技局项目(2018YZQ01031)。

摘　　要：目的探讨端侧吻合技术在个性化游离腹股沟皮瓣移植中的临床应用和效果。方法自2015年3月至2020年7月,收治四肢软组织(骨)缺损患者88例,根据患者创面情况,在髂腹股沟区设计个性化皮瓣,并进行游离移植。皮瓣切取方式:游离旋髂浅动脉穿支皮瓣48例,游离腹壁浅动脉穿支皮瓣7例,带髂骨的复合组织瓣19例,旋髂浅动脉及腹壁浅动脉联合皮瓣8例,旋髂浅动脉及腹壁浅动脉分叶皮瓣6例。皮瓣切取面积为4.0 cm×6.0 cm~10.0 cm×30.0 cm。皮瓣动脉和受区主干动脉均行端侧吻合:与桡动脉吻合36例,与尺动脉吻合12例,与足背动脉吻合18例,与胫前动脉吻合15例,与胫后动脉吻合7例。皮瓣静脉吻合:42例皮瓣吻合2条静脉,分别为同名浅静脉和伴行静脉;46例皮瓣吻合1条同名浅静脉。皮瓣伴行静脉与受区主干动脉的伴行静脉行端侧吻合,同名浅静脉与受区主干动脉的伴行静脉或皮下浅静脉行端端吻合。术后随访内容包括皮瓣血运、肢体远端血运、受区和供区的外观以及患者的满意度。结果 83例皮瓣顺利成活;5例出现血管危象,其中2例术后48 h内出现动脉危象,探查后发现1例为动脉血栓形成,1例为动脉被吻合静脉的血管吻合器压迫所致。另外3例72 h出现静脉危象,探查后发现均为静脉吻合口处血栓形成所致。5例出现血管危象的皮瓣经重新吻合血管或血管转位后全部成活。术后随访时间3~24(平均10)个月,皮瓣移植的供区和受区均愈合良好,皮瓣血运良好,质地柔软;肢体远端无血运障碍。结论端侧吻合技术适用于髂腹股沟区各种形式的游离皮瓣移植,不仅解决供区皮瓣血管蒂偏细的问题,而且可以保留受区肢体的主干动脉,不影响远端血供。Objective To investigate the clinical application and effect of end-to-side anastomosis in personalised free ilioinguinal flap transfer.Methods From March,2015 to July,2020,88 patients with soft tissue(bone)defect of limbs were treated.Different ilioinguinal flaps were designed according to the wound condition of patients,which were 48 cases of free superficial circumflex iliacartery perforator flap,7 cases of free superficial epigastric artery perforator flap,19 cases of composite tissue flap with iliac bone,8 cases of combined flap of superficial circumflex iliac artery and superficial abdominal wall artery,and 6 cases of superficial circumflex iliac artery and superficial abdominal wall artery lobulated flap.The area of the flap was 4.0 cm×6.0 cm-10.0 cm×30.0 cm.The artery and recipient artery were anastomosed end-to-side:36 cases to radial artery;12 cases to ulnar artery;18 cases to dorsalis pedis artery;15 cases to anterior tibial artery;7 cases to posterior tibial artery.Venous anastomosis of skin flap:42 cases were anastomosed with 2 veins,which were superficial vein of the same name and accompanying vein;46 cases were anastomosed with 1 superficial vein of the same name.The accompanying vein of the flap was anastomosed end-to-side with the accompanying vein of the main artery of the recipient area,and the superficial vein of the same name was anastomosed end-to-end with the accompanying vein or subcutaneous superficial vein of the recipient artery.Follow-up includes flap blood supply,blood supply to the distal limbs,appearance of both the donor site and the recipient area,and patient satisfaction.Results There were 83 cases of flaps survived successfully,and 5 cases of crisis.Among them,2 cases had artery crisis at 48 h after surgery.After exploration,it was found that 1 case caused by arterial thrombosis,and 1 case compressed by the stapler that anastomoses the vein.The other 3 cases had venous crisis at 72 h after surgery:after exploration,it was found that caused by thrombosis at the venous anastomot

关 键 词：端侧吻合 髂腹股沟区 腹股沟皮瓣 血管吻合 显微外科技术 

分 类 号：R658[医药卫生—外科学]