数字减影血管造影技术在股前外侧皮瓣修复上肢创面时判断受区血管损伤中的应用  

Application of DSA in the judgment of vascular injury in upper limb wounds repaired by anterolateral femoral flap

作　　者：王强[1] 巨积辉[1] 王臻 金光哲[1] WANG Qiang;JU Jihui;WANG Zhen;JIN Guangzhe(Department of Hand Surgery,Ruihua Affiliated Hospital of Soochow University,Suzhou 215104,China)

机构地区：[1]苏州大学附属瑞华医院手外科,江苏苏州215104

出　　处：《中国美容整形外科杂志》2022年第3期143-146,共4页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：江苏省青年医学人才项目(QNRC2016223)。

摘　　要：目的 探讨在游离股前外侧皮瓣修复上肢创面时利用数字减影血管造影技术(digital subtraction angiography,DSA)判断受区血管损伤情况的效果。方法 自2018年12月至2019年11月,苏州大学附属瑞华医院手外科采用游离股前外侧皮瓣修复上肢创面患者24例,术前采用DSA定位股前外侧皮瓣穿支同时判断受区血管有无损伤,进而确定吻合血管及位置。创面部位:手部10例,腕部4例,前臂5例,肘部4例,上臂1例。创面大小为6.0 cm×4.0 cm~20.0 cm×12.0 cm。皮瓣供区均直接缝合。结果 24例患者术后均未出现造影剂不良反应,皮瓣全部成活。2例皮瓣术后出现血管危象,予积极探查后成活。伤口均一期愈合。所有患者术后获随访6~15个月,皮瓣质地良好,外形不臃肿,感觉恢复S2~S3,大腿供区遗留线状瘢痕,无疼痛及臃肿等不适感,下肢功能正常。结论 游离股前外侧皮瓣修复上肢创面术前采用DSA检查可精确判断受区血管有无损伤,可进一步明确血管吻合位置,避免盲目性,提高手术效率,降低皮瓣坏死率。Objective To explore the clinical value of digital subtraction angiography(DSA) in the judgment of vascular injury in upper limb wounds repaired by anterolateral femoral flap. Methods From December 2018 to November 2019, 24 patients with upper limb wounds were repaired by free anterolateral femoral flap. The DSA was used to locate the perforating branch of anterolateral femoral flap before operation and to determine the location of anastomotic vessels by judging the vascular injury in recipient site. There were10 cases of hand wounds, 4 cases of wrist wounds, 5 cases of forearm wounds, 4 cases of elbow wounds in and 1 case of upper limb wounds.The area of upper limb wounds ranged from 6.0 cm×4.0 cm to 20.0 cm×12.0 cm. The donor site of anterolateral femoral flap was directly sutured. Results No adverse effects of contrast agents were found in 24 patients, and all flaps survived. Two cases of flaps had vascular crisis after operation and survived after active exploration. All wounds were healed in one stage. The follow-up period was from 6 to15 months. The texture of flap was good and the appearance was satisfactory. The sensation recovered from S2 to S3. There was linear scar in the donor site. No pain and edema were found. The function of lower limb was normal. Conclusion The vascular injury could be accurately judged by DSA examination before upper limb wounds repaired by anterolateral femoral flap. The location of anastomotic vessels could be further determined, the operative efficiency could be improved and the necrosis rate of flap was reduced.

关 键 词：股前外侧皮瓣 上肢 血管造影 创面修复 

分 类 号：R658.2[医药卫生—外科学]