供血血管部位及灌注量对动脉化静脉皮瓣成活的疗效分析  

Perfusing flux and location of blood supply vessel on survival of the arterialised venous flap:an analysis of clinical effect

作　　者：陈欣 肖慧敏[1,2] 余雅玲 文根 CHEN Xin;XIAO Huimin;YU Yaling;WEN Gen(College of Fisheries and Life Science,Shanghai Ocean University,Shanghai 201306,China;Department of Orthopaedic Surgery,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海海洋大学水产与生命学院,上海201306 [2]上海交通大学医学院附属第六人民医院骨科,上海200233

出　　处：《中华显微外科杂志》2024年第2期160-164,共5页Chinese Journal of Microsurgery

基　　金：上海市教委科研创新项目(201901070002E00043)。

摘　　要：目的探讨改善血管灌注量及位置对动脉化静脉皮瓣成活的影响。方法采用回顾性病例系列研究分析2016年7月至2020年7月上海市第六人民医院骨科收治的13例接受改善动脉灌注量及位置的动脉化静脉皮瓣患者的临床资料,其中创伤性软组织缺损10例,肿瘤切除术后软组织缺损1例,再造术后供区软组织缺损2例;11例缺损位于手部,2例位于足部;软组织缺损面积为3.0 cm×2.0 cm~10.0 cm×8.0 cm,皮瓣面积为3.5 cm×2.0 cm~10.0 cm×8.0 cm。动脉化静脉皮瓣常规切取完成后,将输血血管由皮瓣边缘向皮瓣内部游离,输入血管的游离长度不超过该血管在皮瓣内行程全长的1/2,以实现动脉血由皮瓣内部进入皮瓣。受区存在多组动脉血管时,优先选择血管管径较大的动脉血管作为供血动脉,以实现提高皮瓣动脉血灌注量的目的。供区12例直接拉拢缝合,1例植皮覆盖创面,术后监测皮瓣颜色、温度、肿胀及毛细血管返流等指标,并定期回院门诊复诊随访。结果本组11例皮瓣完全成活,2例皮瓣边缘部分坏死,后经换药后愈合。术后随访6~18(平均10.9)个月。所有皮瓣都完成了重要组织结构的覆盖,皮瓣颜色、质地与受区皮肤相似,外观满意。结论与传统动脉化静脉皮瓣相比,改善血管灌注量和位置可能是提高动脉化静脉皮瓣成活的有效方法。Objective To investigate the effect of improved amount and location of vascular perfusion on the survival of arterialised venous flaps.Methods A retrospective study was conducted to analyse the clinical data of 13 patients who received transfer of arterialised venous flaps to improve arterial perfusion and location at the Department of Orthopaedic Surgery Shanghai Sixth People's Hospital from July 2016 to July 2020.The causes of the defects were:10 of traumatic tissue injury,1 of tumour surgery and 2 of surgical damage at the flap donor site.There were 11 defects in hand and 2 in foot.The size of soft tissue defects varied from 3.0 cm×2.0 cm to 10.0 cm×8.0 cm.The size of flaps was 3.5 cm×2.0 cm-10.0 cm×8.0 cm.The surgical procedures were:after the completion of conventional harvest of the arterialised venous flap,the blood influx vessel was freed from the edge of the flap towards inside of the flap,with a length of the freed vessel being less than 1/2 of the full length of the vessel in the flap,in order to ensure that the arterial blood perfusion of the flap was actually from inside of the flap.If multiple arterial vessels existed in the recipient area,a large arterial vessel was selected as the supplying artery to achieve an increasing arterial blood perfusion to the flap.In the donor site,12 cases were directly drawn and sutured,and 1 case was covered by skin grafting.The colour,temperature,swelling and capillary reflux with other indicators of the flap survival were closely monitored after surgery.Results All patients entered the postoperative follow-up for an average of 10.9(6-18)months.Eleven flaps were fully survived and 2 flaps had partial necrosis at the edges.All flaps covered the important tissues and structures of the defects.The colour and texture of flaps were similar to the skin of the recipient sites,with a satisfactory appearance.Conclusion Improved amount and location of vascular perfusion would be an effective way to improve the survival and quality of the arterialised venous flaps,in compa

关 键 词：动脉化静脉皮瓣 血管灌注量 血管灌注位置 皮瓣成活 

分 类 号：R658[医药卫生—外科学]