逆行推出皮支内脱落血栓解除皮瓣动脉危象

Elimination of arterial crisis in free skin flap transplantation by reversely milking out the detached thrombus in cutaneous branch

目的：研究因动脉吻合口脱落微血栓造成游离皮瓣皮支栓塞的临床表现和处理技术。方法：在２例皮瓣移植术中，确认动脉吻合口通畅而移植皮瓣无血供后，于高倍显微镜下由吻合口向远端探查并剥离外膜，发现脱落的微血栓堵塞在皮支入瓣分叉部，遂以显微镊子轻柔地逆行推走或推出微血栓。结果：成功地解除了动脉危象，２例皮瓣完全成活。结论：逆行推走栓塞在皮支的脱落微血栓。

Objective: To introduce the clinical manifestation and the solutions of vascular crisis in free skin flap caused by the obstruction of the sole cutaneous branch by microthrombus detached from the arterial anastomotic site. Methods: Two cases of free skin flap transplantation were reported. When the state was confirmed that there was no blood supply to the flap whereas the arterial anastomosing site was patent,exploration of the artery distal to the anastomosing site was done under operative microscope.After peeling off the adventitia,the detached microthrombus was found obstructing in the furcation of the sole cutaneous branch.The thrombus was then gentlely milked out of the cutaneous branch using microsurgical forceps. Results: The arterial crisis of the free skin flaps was eliminated, and two flaps survived. Conclusion: Reverse milking out the detached microthrombus was an effective measure to obviate this kind of arterial crisis.