下肢静脉曲张微创旋切术后皮肤软组织坏死的原因及处理

The reason and treatment of skin soft tissue necrosis caused by low limb superficial varicosities treated with minimally invasive rotary varicotomy

目的:分析下肢静脉曲张微创旋切术后皮肤软组织坏死的原因,并总结治疗经验。方法:2007年12月～2009年2月,采用不同的修复方法治疗10例下肢静脉曲张微创旋切术后创面,对其临床治疗进行分析总结。结果:术后不同时期的创面均予以彻底切除坏死组织,培养新鲜肉芽组织;周围有正常组织者,采用局部皮瓣转移修复;周围无正常组织者,应用简易封闭负压治疗技术,创面局部环境改善后,行局部皮瓣或皮片移植修复。皮瓣转移4例,2例皮瓣100%成活;2例皮瓣部分坏死,经再次清创,移植皮片成活;其余6例均行皮片移植术,皮片均100%成活。经术后1～10月随访,功能恢复满意。结论:根据下肢静脉曲张行旋切术后皮肤软组织坏死的特点,必需在彻底切除坏死组织后,延期修复创面,以中厚皮片移植修复为首选,慎选局部皮瓣转移。

Objective To analyze the reasons and summarize the therapeutic experience of skin soft tissue necrosis caused by low limb superficial varicosities treated with minimally invasive rotary varicotomy. Methods Different surgical methods were employed in 10 patients with skin soft tissue necrosis in low limbs from December,2007 to February,2009. Results Necrotic tissue was excised completely and granulation tissue was cultivanted in different period. The local skin flaps or free skin grafts were used to repair wounds after the local conditions of wounds were improved by facility vacuum-assisted closure technology.The survived rate of free skin grafts in 6 cases was 100%. Local skin flaps were carried out in 4 cases,among them,two flaps totally survived and the others showed partly necrosis in remote part of the flaps,the necrosis tissues were excised thoroughly and free skin grafts were employed to repair the wounds. The follow- up results from one to ten months post-operation showed the function recovered satisfactory. Conclusions According to the characteristics of skin soft tissue necrosis caused by low limb superficial varicosities treated with minimally invasive rotary varicotomy,the wound would be repaired delayedly after necrosis tissue were thoroughly excised. Free skin grafts might be a first choice to repair those wounds, and it must be cautious to select skin flap.