口腔颌面部游离皮瓣危象的预防和处理

Prevention and treatment of failing flaps in oral and maxillofacial surgery

目的：本文结合临床资料和文献报道，对口腔颌面部游离皮瓣危象的发生机制、防治措施等进行了探讨。方法：总结引起游离皮瓣发生缺血一再灌注损伤的各种因素及机制，评价各种术后监测方法，重点介绍危象皮瓣的手术探查，各种情况的处理，提出防止游离皮瓣发生血管危象的措施。结果：自１９７９年开展游离组织瓣移植手术至今，我科共累积病例１１５１例，手术后１４８例出现血管危象，抢救成活８９例，抢救成功率６０．１％，高于国外同类报道（４０％）。结论：选择合适的病例／皮瓣，术中精心操作，尽量缩短缺血时间，仍是目前确保游离组织移植成功的最重要因素，局部或全身应用药物防治危象皮瓣，仍需进一步研究。

Purpose:To investigate the pathogensis of failing flaps in oral and maxillofacial surgery and the prevetive measures for flap failure, hased on our clinical data in 1151 patients, with an emphasis on surgical exploration of failing flaps. Methods: The various factors related to flap ischemia - reperfusion injury and the pathogenesis were reviewed. The multiple methods for flap monitoring were evaluated. Surgical exporation of failing flaps was described in detail and the precautions for failing flaps were proposed. Results: A total of 1151 free tissue transfers were performed in our department since 1979. 148 flaps developed vascular crisis, 89 were successfuly sal- vaged, with a success rate of 60.1 %, higher than that reported abroad(40 %) ; Conclusions: Selection of appropriate patients and/or flaps, careful manipulation intraoperatively and minimizing ischemic time as much as possible are still the main factors that ensure Success of free tissue transfers. Further study is needed for topical topical systematic use of drugs to prevent and treat failing fialps.