微血管吻合器在头颈部缺损皮瓣移植静脉端端吻合中的应用

End-to-end venous anastomosis using the microvascular anastomotic in head and neck detects reconstruction with free flaps

目的探讨微血管吻合器在头颈部缺损游离皮瓣移植静脉端端吻合中应用的可靠性。方法12例游离皮瓣重建头颈部缺损，其中放射性下颌骨坏死3例，上颌骨纤维异常增殖1例；上颌窦黏液表皮样癌、鳞癌各1例，复发下牙龈鳞癌1例，颊鳞癌1例，舌鳞癌4例，分别采用腓骨肌皮瓣、股前外侧皮瓣、前臂皮瓣同期修复缺损。静脉采用微血管吻合器端端吻合，共用13枚吻合器。结果12例游离皮瓣静脉吻合口无渗血，术中阻断实验显示静脉通畅、充盈良好；术后皮瓣全部成活。吻合时间较手工吻合明显缩短，平均吻合每条静脉时间约为5．3min。术后随访1～9个月，吻合区愈合良好，无排异反应。结论微血管吻合器应用于头颈部游离皮瓣重建静脉端端吻合可明显缩短吻合时间，操作简便，吻合质量可靠。

Objective To assess the reliability and useness of using a coupling device for end-to-end venous anastomosis in patients undergoing free-tissue transfer in head and neck reconstruction. Methods Twelve patients undergoing surgical resection and head and neck defects were repaired with fibular flap, anterolateral thigh flap and radial forearm flap. The microvascular anastomotic device was used to perform venous anastomosis in these cases. Flap survival and thrombosis of the venous anastomoses were determined. Results There were no flap losses due to venous thrombosis in this series. The venous anastomosis was usually coupled in about 5.3 minutes and appear as an obviously time savings compared with performing a hand-sewn venous anastomosis. Conclusion The microvascular coupler is excellent in end-to-end venous anastomosis and certainly less taxing on the surgeon when compared with standard suture techniques.