前臂桡侧游离皮瓣静脉回流障碍的临床观察:附13例报道

Clinical analysis of venous compromise of the radial forearm free flap : a retrospective study of 13 cases

目的:探讨前臂桡侧皮瓣(radial forearm free flap,RFFF)移植术后静脉危象的临床治疗。方法:选择因口内软组织缺损接受RFFF移植修复的患者178例,回顾分析其中因静脉危象行手术探查的13例患者的临床资料。采用SPSS11.5软件包对数据进行统计学处理。结果:13例发生静脉回流障碍的病例经手术探查后,9例抢救成功,4例失败。其中,6例吻合2条静脉(失败2例),7例吻合1条浅静脉(失败2例)。除1例埋入瓣外,所有进行探查的皮瓣均出现颜色改变。4例出现皮瓣边缘渗出性出血,至皮瓣渗血停止、出现颜色变化后才进行手术探查。结论:RFFF发生危象主要是由于局部静脉回流障碍,吻合2条静脉与1条静脉相比,危象发生率与抢救失败率无显著差异。发生静脉危象时,皮瓣颜色由远及近改变,主要是由于远端静脉回流障碍所致。术后皮瓣边缘渗出性出血是静脉回流障碍的早期表现,应及时检查。静脉回流障碍时间越长,血栓范围越大,皮瓣坏死的可能性越大。

PURPOSE： To achieve a more general recognition of venous compromise in radial forearm free flap（RFFF）.METHODS： Out of 178 patients who underwent RFFF transfer for intraoral reconstruction,13 patients were identified and required exploration due to venous-related problems.A retrospective study was performed on all patients undergoing exploration.SPSS 11.5 software package was used for statistical analysis.RESULTS： Nine flaps were salvaged and 4 flaps were lost.Among the 13 flaps,6 involved both deep and superficial venous system（2 failed） and 7 cases involved only one venous pedicle（2 failed）.Except for one buried flap,all flaps that require exploration had a change in flap color.Oozing of blood from the edge of flap was found in 4 flaps after operation.The explorations were not carried out until the flaps exhibited a color change,which confirmed that venous-related problems occurred in these flaps.CONCLUSIONS： Venous compromise is the most common causes of flap failure.In our experiences,there seems no significantly difference between single and dual venous anastomosis in the success rate of flap.The skin paddle color changed from distal to proximal end of the flap when vascular pedicle occlusion happened.Our clinicopathological studies indicate the major factor of this phenomenon is venous congestion rather than arterial insufficiency in the distal area.Oozing of blood from the flap is directly related to venous congestion in the early postoperative period and timely surgical intervention is required.The longer time venous compromise lasts,the larger extent of thrombosis occur,the more chance that leads to irreversible flap necrosis develops.