肢体人工血管移植物外露的外科治疗

Surgical Management of Limb Prosthetic Vascular Graft Exposure

目的探讨肢体人工血管移植术后血管移植物外露的危险因素及外科治疗方法。方法回顾性分析了2006年8月至2011年12月在北京协和医院血管外科诊治的17例肢体人工血管移植术后血管移植物外露患者的临床资料,外科治疗主要包括局部治疗及保留移植物的任意皮瓣或肌皮瓣转移覆盖术。结果 17例患者均行保留移植血管的(肌)皮瓣转移覆盖术,术后14例成功保全了人工血管,切口Ⅰ期愈合,动脉搏动良好,成功率82.4%;3例术后未顺利愈合,最终切除血管移植物。结论保留血管移植物的(肌)皮瓣转移覆盖术是肢体人工血管移植物外露的有效外科处理手段。

Objective To investigate the risk factors and surgical management of limb prosthetic vascular graft exposure.Methods The clinical data of 17 patients suffering from limb prosthetic vascular graft exposure in Peking Union Medical College Hospital from August 2006 to December 2011 were retrospectively analyzed.Among 17 cases,5 suffered from prosthetic vascular graft exposure after vascular bypass for the lower limb ischemia,whereas 12 were affected after the artificial graft arteriovenous fistula construction in the upper limbs for hemodialysis.The surgical procedures mainly included the local debridement as well as the local flap and transferred muscle-cutaneous flap reconstruction to preserve the prosthetic vascular graft.Results All 17 patients underwent local flap or muscle-cutaneous flap coverage procedure.After the surgery,the prosthetic vascular graft was successfully salvaged in 14 cases.The total successful rate was 82.4%.The surgery failed in three patients,in whom the prosthetic vascular grafts were finally removed.Conclusion Local flap and transferred muscle-cutaneous flap reconstruction is an effective surgical management to salvage the exposed grafts.