头颈部游离组织瓣血管危象的预防和处理

Postoperative Vessel Thrombosis and Its Management after Free Flap Transfers in Head and Neck Region

目的:探讨如何预防和处理口腔颌面部游离组织瓣血管危象。方法:对我科1998年1月至2008年7月间完成游离组织瓣移植手术的230例患者临床资料进行回顾性研究,分析成功预防和处理头颈部游离组织瓣血管危象的因素。结果:本组采用5种游离组织瓣修复,共231块,包括前臂皮瓣、股前外侧皮瓣、背阔肌皮瓣、腓骨肌皮瓣、髂骨肌皮瓣;临床成功率为96.1%,术后血管危象的发生率为9.1%,抢救成功率为57.1%。结论:组织瓣类型及受区血管的合理选择,熟练的皮瓣制备和血管吻合技术,患者的基础情况以及术后有效的血运监测是头颈部游离组织瓣血管危象预防和处理的主要因素。

Objective： To analyze the rate of postoperative vessel thrombosis and its management after free tissue transfers in head and neck region.Methods： 230 consecutive free flap transfers performed from January of 1998 to July of 2008 were reviewed.We analyzed primary disease,defect of tissue,type of flap and complications to conclude the factors related to the reconstruction of free flap.Results： Five kinds of free flap were used： free fibular flap,free radial forearm flap,free anterolateral thigh flap,free ilium flap,and free latissimus dorsi flap.The overall success rate of free flap was 96.1%.The vessel crisis rate was 9.1%,and the flap salvage rate was 57.1%.There were no serious complication.Conclusion： The type of flap,the practice operation,the suitable selection of blood vessel,the basic condition of patients,and the effective monitoring operation play important parts in the reconstruction of free flaps.