改良血管端侧吻合方式在游离穿支皮瓣修复创面中的应用  

Clinical application of modified end-to-side anastomosis in wound repair by free perforator flap

作　　者：郑颂耀 王静 马立保 刘奕璠 张圣星 俞亮 彭志祥 曾政 何鸿业 ZHENG Songyao;WANG Jing;MA Libao(Department of Hand-Foot Microsurgery,Huiyang Sanhe Hospital,Huizhou,Guangdong,526211,China)

机构地区：[1]惠阳三和医院手足显微外科,广东惠州526211

出　　处：《实用手外科杂志》2022年第4期512-514,526,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨改良血管端侧吻合方式在游离穿支皮瓣修复四肢软组织缺损创面中的临床疗效。方法对2021年6月-12月收治的16例四肢软组织缺损创面均采用游离穿支皮瓣并行改良血管端侧吻合的方式修复。游离穿支皮瓣来源于桡动脉掌浅支腕横纹穿支皮瓣及股前外侧动脉斜支穿支皮瓣。术后严密观察皮瓣血运及成活情况,随访创面外观及皮瓣质地、弹性,供区瘢痕增生、感觉功能恢复情况。结果术后皮瓣均顺利成活且血运良好,随访12~20(16±2)周,皮瓣外观、质地及弹性良好,无色素沉着,供区存留线性瘢痕,无感觉功能异常,临床效果满意。结论游离穿支皮瓣血管蒂部动脉行改良端侧吻合的方式,更符合血流动力学原理,不损伤受区血供,安全可靠,临床疗效满意。Objective To investigate the clinical effect of wound repair by free perforator flap with end-to-side anastomosis.Methods A retrospective observational study was performed on 16 patients with wound defect repair who met the inclusion criteria and were admitted to hand-foot microsurgery department of Huiyang Sanhe Hospital from June 2021 to December 2021.The wound was repaired by free perforator flap with end-to-side anastomosis.There were two types of free perforator flaps:superficial palmarar wrist perforator flaps of radial artery and oblique perforator flaps of anterolateral femoral artery.The donor wrist was sutured subcutaneously,and the skin was closed with intradermal sutures.The skin was sutured layer by layer and the skin was sutured intradermal.End-to-side anastomosis was performed between the vascular artery of the flap and the artery of the recipient area,including one artery,and anastomosis of 1-2 veins.Blood supply and survival of the flap were observed after surgery.The shape of the wound,texture and elasticity of the flap,scar hyperplasia at the donor site,and abnormal sensory function at the donor site were observed.Results All the flaps of the patients who underwent wound repair with end-to-side anastomotic free perforator flaps survived successfully and had good blood supply.The patients were followed up for 12-20(16±2)weeks,and satisfied with the appearance,texture and elasticity of the flap,linear scar at the donor site,and no abnormal sensory function.Conclusion End-to-side anastomosis of the pedicle artery of free perforator flap is more in line with the principle of hemodynamics,without damaging the blood supply of the affected area,which is a safe,reliable and satisfactory option.

关 键 词：皮肤创面修复 血管端侧吻合 桡动脉掌浅支腕横纹穿支皮瓣 股前外侧动脉斜支穿支皮瓣 血流动力 

分 类 号：R622[医药卫生—整形外科]