游离皮瓣移植1270例回顾性研究

A retrospective study of 1270 cases with free flap transplantation

目的通过游离皮瓣病例的回顾性研究，寻找发现皮瓣手术过程存在的问题并分析其原因，找出预防、解决方法，为同道提供参考。方法对2000年10月至2010年10月间在本院治疗的1270例游离皮瓣、肌皮瓣及穿支皮瓣病案资料回顾性研究，其中对722例进行随访研究，随访时间6个月～5年。从皮瓣设计、切取、移植、供受区的处理以及修复后功能等几个方面找寻存在的问题和缺陷，逐项分析原因，并根据临床经验和教训，提出预防及应对的措施和方法。结果1270例皮瓣，因故放弃和失败64例，成功率为95．0％，术后皮瓣坏死率为3．8％。发生血管危象76例，其中动脉危象42例，静脉危象34例，经局部保守处理挽救55例，手术挽救成功15例，5例部分成活，失败7例。本组急诊皮瓣手术682例，感染率仅为4．7％。慢性创面588例，感染率为8-8％。慢性创面感染率远高于急诊创面。结论预防和及时处理血管危象是保障皮瓣成活的关键。严格遵守皮瓣切取原则，控制好修饰性切取适应证，注意皮瓣张力是皮瓣手术的技术要求。手术供区正确封闭处理方式，是预防、解决并发症及功能不良的有效方法。

Objective Evaluate data of 1270 eases with free flap transplant, to find the problems in the process of operation, and then to analyse its causes and how to prevent and solve it, as well as providing reference for clinical colleagues. Methods To study 1270 eases of free flaps, museulocutaneous flap and perforator flap who was treated in our hospital from October 2000 to October 2010 retrospectively. A total of 722 eases of the group were followed-up 6 months to 5 years. To detective and search the problems and im- perfection from designing, harvesting, tranfer, to the management and function of donor site after free flap transplantion. And also to analysis the eouse of problems and operation failure, discuss the conclude of and to provide advisable measure. Results Total 1270 free flaps were transplanted successfully except 64 can- celled or failured for some reason, the success rate was 95.0%, the postopertive necrosis rate was 3.8%. Seventy-six eases were encountered vascular complications venous crisis in 42, arterial crisis in 38. Fifty-five eases were saved successfully without surgery, and 15 eases survived completely by vessel explorative opera- tion. Five eases were partial necrosis and 7 eases necrosis. The rate of postoperative infection of emergency eases and ehronic one were 4.7% （682 cases）and 8.8%（588 cases） which show the infective incidence of latter was higher than former. In addition, there were many other problems were found such as distal flaps necrosis, contracture, deformation, impairment function of doner site, etc. Conclusion Preventing and management timely to vessle crisis is the key to flap suvive. The principle of dissecting flap should be fol- lowed strictly, and control the indications of modified processing during flap harvest, keep the proper flap tension were technical requirements in flap transplantion. Right way of donor site closed and management of insufficient timely were equally important to prevent and solve to complications and dysfunction.