微血管吻合器在皮瓣修复颌面缺损的应用体会

The application of microvascular coupler during repairing oral and maxillofacial defects via free flaps

目的:观察口腔颌面部肿瘤术后缺损行修复重建手术中应用微血管吻合器吻合静脉的效果。方法:选取口腔颌面部肿瘤需行游离皮瓣局部修复的患者20例,应用微血管吻合器术中吻合静脉系统,动脉仍使用传统手法吻合。结果:应用吻合器行静脉吻合平均用时(5.75±0.53)min,所有病例未见血栓形成。实验组1例皮瓣因动脉痉挛缺血坏死,成活率95%(19/20)。实验组1例术后颈部出血,探查清除血凝块时见静脉吻合口处回流依然通畅,皮瓣愈合未受影响;另有1例因血管壁较厚,吻合口张力过大术中吻合器松脱,予以手法缝合。结论:在选择好恰当的适应证的前提下微血管吻合器的使用明显缩短了手术时间,而不影响血管吻合效果;吻合口张力过大或静脉壁较厚者应提防吻合器松脱的可能。

Objective:To evaluate the effect of venous anastomosis by using microvascular coupler during repair and reconstruction surgery after recection of tumor in oral and maxillofacial area.Methods:20patients with oral and maxillofacial tumor were chosen for repair of the defects via free flap.Microvascular coupler was applied to combine venous system,however,traditional methods were used in arterial anastomosis.Results:The average time of venous anastomosis using microvascular coupler was(5.75±0.53)min,none of the chses were suffered from thrombosis after surgery.Vascular nerosis resulted from arterial spasm occured in1flap,reaching the flap survival rate of95%(19/20).Neck bleeding occurred in1case after surgery,the reflux of the anastomosed vein went smoothly when the blood clot was cleared,flap healing was unaffected.In another case,the coupler released during the surgery due to thick blood vessel wall as well as hypertension among the anastomotic edge,the vessels were manually sutured.Conclusion:With the appropriate indications,application of microvascular coupler may shorten the operating time,without affecting the effect of vascular anastomosis.The possibility of coupler loosing should be Harmed when bumped into great anastomotie tension or thick wall of the vein.