扩张皮瓣转移术后血运障碍的原因分析与处理

The cause and management of the disorder of blood supplying of expanded flaps after reconstruction

目的探讨扩张皮瓣转移术后血运障碍的原因及预防处理的措施。方法对采用扩张皮瓣转移修复治疗的325例患者、903个扩张皮瓣进行回顾性研究，将相关数据进行统计学分析并对其处理方法进行总结。结果扩张皮瓣发生血运障碍者43例（4．76％）；发生部位：上肢11例、躯干部12例、颈部8例、下肢1例、头面部11例。采用局部皮瓣修复28例，邻位皮瓣修复7例，远位皮瓣修复8例。扩张皮瓣发生血运障碍的原因：皮瓣长宽比例过大12例、皮瓣中央过薄7例、血肿8例、感染4例、皮瓣张力过大4例、瘢痕组织皮瓣5例、切除包膜3例。结论扩张皮瓣血运障碍的发生与扩张部位、皮瓣类型有关；局部皮瓣较邻位皮瓣和远位皮瓣的血运障碍发生率低；对长宽比例过大的远位或邻位扩张皮瓣，采用皮瓣延迟术，能减轻瘀血的发生，有利于扩张皮瓣成活。

Objective To investigate the cause and management of the disorder of blood supplying of ex- panded flaps after reconstruction. Methods Totally 325 patients with 903 expanded flaps were reviewed retro- spectively for the disorder of blood supplying. The data concerned were analysed statistically, and the therapeutic methods were also summarized. Results The number of disorder of blood supplying of the expanded flaps ： total 43 （4.76%）, upper limbs 11, trunk 12, neck 8, lower limbs 1, head and face 11, local skin flap 28, ortho-po- sition skin flap 7, distant skin ilap g. The cause of the disorder of blood supplying of expanded flaps： large length to width ratio 12, thin of expanded flap in central part 7, hematoma 8, infection 4, large of flap tension 4, con- taining scar tissue in expanded flap 5, removal of envelope 3. Conclusion There is a significant relationship between the disorder of blood supplying of expanded flaps and expanded positions. There is also a significant re- lationship between the disorder of blood supplying of expanded flaps and the pattern of expanded flaps. The lo- cal skin flaps have lower incidences of disorder of blood supplying than the ortho-position and distant skin flaps. As to the distant and ortho-position skin flaps with large length to width ratio, the flap delaying operation can improve the survival of the expanded skin flap.