断指(肢)再植、游离皮瓣术后静脉血栓栓塞症3例  

The analysis of three cases of venous thromboembolism after reimplantation and flap surgery

作　　者：向湘华 黄秋萍 黄阿勇 XIANG Xianghua;HUANG Qiuping;HUANG Ayong(Department of Hand Surgery,Quanzhou Orthopedic-Traumatological Hospital of Fujian Province,Quanzhou,Fujian,362000,China)

机构地区：[1]泉州市正骨医院手外科,福建泉州362000 [2]泉州市正骨医院药剂科,福建泉州362000

出　　处：《实用手外科杂志》2023年第3期349-351,402,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨断指(肢)再植、游离皮瓣术后发生静脉血栓栓塞症(Venous thromboembolism VTE)的原因及防治对策。方法回顾性分析泉州市正骨医院手外科2020年10月-2022年1月收治的断指再植、断肢再植、游离皮瓣病例中发生静脉血栓栓塞的3例病例资料,其中断指再植1例、断肢再植1例、游离股前外侧皮瓣1例,分析发生静脉血栓栓塞的原因及防治方法。结果断指再植患者发生左侧下肢深静脉血栓栓塞,抢救成功;断肢再植患者发生肺栓塞,抢救成功;游离股前外侧皮瓣患者发生下肢深静脉血栓栓塞及肺栓塞,抢救无效。结论再植、皮瓣术后患者血液常呈现高凝状态,需要选择合适的抗凝药物及剂量进行抗凝治疗;绝对卧床患者需要指导床上功能训练、增加物理治疗及药物治疗以预防静脉血栓栓塞;股前外侧皮瓣供区不宜缝合过紧;断指(肢)体再植、皮瓣术后不宜外固定或固定时间不宜过长,固定期间需及时指导功能训练,尽量恢复患肢功能;股前外侧皮瓣等手术时间长者术前宜完善下肢动静脉彩超检查,明确患者既往史。Objective To discuss the causes of venous thromboembolism VTE(Venous thromboembolism VTE)after replantation of severed fingers and limbs with free flaps and the prevention and control measures.Methods By reviewing the cases of severed finger reimplantation,severed limb reimplantation,and free flap treated in the Department of Hand Surgery,Quanzhou Orthopedic-Traumatological Hospital from October 2020 to January 2022,a total of 3 cases in which venous thromboembolism occurred were selected for analysis.The causes of venous thromboembolism and the methods of prevention and treatment were analyzed in one case of finger replantation,one case of limb replantation,and one case of free anterolateral femoral flap.Results The patient with amputated fingers had left lower extremity deep vein thromboembolism and were successfully resuscitated,The patient with amputated limbs had pulmonary embolism and were successfully resuscitated,and the patient with free anterolateral femoral flap had lower extremity deep vein thromboembolism and pulmonary embolism and were ineffectively resuscitated.Conclusion Patients'blood is often hypercoagulable after reimplantation and flap surgery,so it is necessary to select appropriate anticoagulant drugs and take anticoagulation therapy;patients who are absolutely bedridden should be instructed to take functional exercises in bed and increase physiotherapy and medication to prevent venous thromboembolism;the donor area of anterolateral femoral flap should not be sutured too tightly;finger(limb)reimplantation and flap should not be fixed externally or for too long time after surgery,and functional exercises should be instructed in time during fixation to restore the function of the affected limb as much as possible;preoperative ultrasound examination of the arteries and veins of the lower extremities should be improved for those who have been operated on for a long time such as anterolateral femoral flap;the past history of patients should be clarified.

关 键 词：股前外侧皮瓣 再植 游离皮瓣 静脉血栓栓塞 

分 类 号：R658.1[医药卫生—外科学] R543.6[医药卫生—临床医学]