不同皮瓣修复手部组织缺损术后血液循环变化特点的观察

Observation of blood circulation change in different flaps repair surgery for hand tissue

目的比较游离生理皮瓣、筋膜蒂皮瓣、静脉皮瓣、皮神经营养皮瓣术后皮瓣的颜色、温度、张力及毛细血管充盈消失在不同时段变化情况，为临床治疗提供依据。方法选择手部组织缺损需行皮瓣移植修复的患者221例，按照不同皮瓣移植组织分为4组，其中游离生理皮瓣组50例，筋膜蒂皮瓣组66例，静脉皮瓣组57例，皮神经营养皮瓣组48例。采用围手术期现场调查的方法，比较4组皮瓣在术后不同时段颜色、温度、张力及毛细血管充盈消失的变化情况。结果4组患者皮瓣血循环情况比较，游离生理皮瓣组灰白发生率20％、暗红发生率38％、极度肿胀发生率32％、毛细血管充盈消失发生率8％，均低于其他3组，差异有统计学意义（Х^2值分别为20．64，49．90，36．99，36．16；P〈0．01）。结论4类皮瓣应重点关注术后48h内血液循环变化情况，皮瓣灰白观察期可缩短至术后2h，游离生理皮瓣毛细血管充盈消失可缩短至术后12h，筋膜蒂皮瓣在术后7d内各项指标需全程观察。

Objective To compare the color, temperature, tension and capillary filling in different flaps repair surgery, including free physiological flap, fascial pedicle skin flap, venous skin flap and cutaneous neurotrophic skin flap,so as to provide some directions for clinical observation. Methods From March 2011 to December 2011, totals of 221 patients with 223 flaps were involved in this study. They were divided into four groups ： free physiological flap group （ n = 50）, fascial pedicle skin flap group （ n = 66）, venous skin flap group （ n = 57）, cutaneous neurotrophic skin flap group （ n = 48）. The peri-operation investigation was adopted, and the color, temperature, tension and capillary filling in different flaps after operation were observed and compared. Results In free physiological flap group, the incidence of grey and dark red respectively was 20% and 38%, and the rate of tension bullae and disappearing of capillary filling respectively was 32% and 8%, which was significantly lower than that in others groups （Х^2 = 20.64,49.90,36.99,36.16, respectively; P 〈 0.01 ）. Conclusions The blood circulation change must be paid more attention within 24 hours after operation in all the four flap. The observation of grey stage could be shortened to 2 hours, and the disappearing of capillary filling could be 12 hours. The four index of blood circulation of faseial pedicle skin flap must be observed within 7days after operation.