前额带蒂皮瓣断蒂前皮瓣血循环训练方法的对比研究  

Comparative study on blood circulation training methods of the forehead pedicled flaps before the pedicles division

作　　者：王珏[1] 闵沛如[2] 肖文天 章一新[2] WANG Jue;MIN Peiru;XIAO Wentian;ZHANG Yixin(Department of Plastic And Burn Surgery,Zaozhuang Municipal Hospital,Zaozhuang 277100,China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]枣庄市立医院整形烧伤科,山东省枣庄市277100 [2]上海交通大学医学院附属第九人民医院整复外科,上海市200011

出　　处：《组织工程与重建外科》2022年第5期415-418,共4页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的前额带蒂皮瓣在断蒂前进行皮瓣血运训练有助于增加皮瓣的血供。临床上常用橡皮筋缠绕法以阻断蒂部血流,再用血管钳夹住橡皮筋固定。我们应用一种新的皮瓣缺血训练方法,并将其与橡皮筋法进行疗效对比。方法尼龙扎带阻断法由带卡扣的自锁尼龙扎带和橡胶管来完成。在扎带外套上胶管,以增加其柔软性,扎带在皮瓣蒂部收紧以阻断来自蒂部的血流灌注。分别使用尼龙扎带法及橡皮筋阻断法,比较两者的临床效果、可靠性、可重复性及患者的疼痛耐受性。结果共收集30例行前额皮瓣鼻再造的患者。相比橡皮筋阻断法,尼龙扎带松动的发生率更低(8.7%vs 19.6%,P<0.05),能更有效地维持收缩力。尼龙扎带法的疼痛评分显著低于环扎橡皮筋法(3.25±1.12 vs 7.05±1.02,P<0.05),尤其在儿童患者中(3.50±0.88 vs 8.60±1.23,P<0.01)。所有患者均在一期术后19~21 d成功完成断蒂手术,且无术后并发症。结论与橡皮筋阻断法相比较,使用尼龙扎带的可靠性、可重复性更佳,患者的耐受性也更好,推荐使用尼龙扎带作为前额皮瓣断蒂前皮瓣缺血训练的首选方法。Objective Blood circulation training of the forehead flap prior to pedicle division helps to improve blood supply to the flap.Clamping the pedicle by a clamped rubber band with vessel forceps is often clinically applied.To introduce an innovative method designed for ischemic training and compared its efficacy with the clamped rubber band.Methods The nylon tie blocking method is performed by self-locking nylon cable tie with a buckle and a rubber tube.The rubber tube is fed over the cable tie to act as a soft outer lining and the cable tie is tightened across the pedicle to block the perfusion from the pedicle.The nylon tie and the clamped rubber band were applied respectively before division surgery.The constriction effect,reliability,reproducibility,and the patients'pain tolerance were compared.Results A total of 40 forehead flaps were included.The cable tie had less incidence of loosening(8.7%vs.19.6%,P<0.05)and maintained the pressure more effectively.The pain score for the nylon cable tie was significantly lower than the clamped rubber band(3.25±1.12 vs.7.05±1.02,P<0.05),especially for pediatric patient(3.50±0.88 vs.8.60±1.23,P<0.01).All 20 pedicles were successfully divided at 19 to 22 days with no surgical complications.Conclusion Compared with the clamped rubber band,the cable tie produces a more reliable and reproducible ischemic preconditioning effect.It is also better tolerated by the patients.Therefore,it is recommend to use the nylon cable tie as the first choice for ischemic preconditioning of the forehead flap before the pedicle is broken.

关 键 词：前额皮瓣 血循环训练 断蒂术 鼻再造 

分 类 号：R622[医药卫生—整形外科]