动脉和静脉完全换位在游离皮瓣动脉危象中的临床应用

Clinical application of complete transposition of arteriovenous in free flap artery crisis

目的探讨动脉和静脉完全换位在游离皮瓣动脉危象中应用的临床疗效。方法2009年10月至2017年4月,对13例四肢软组织缺损患者采用游离皮瓣修复,皮瓣血管吻合后出现顽固性动脉危象,反复吻合血管均不能缓解,遂将皮瓣内的动、静脉完全换位与受区处动、静脉吻合,即皮瓣内静脉与受区动脉吻合重建皮瓣血供,皮瓣内动脉与受区静脉吻合重建皮瓣回流。其中游离下腹部皮瓣5例,股前外侧皮瓣8例;修复手部创面10例,小腿创面3例。软组织缺损面积16cm×7cm^6cm×4cm;皮瓣面积18cm×8cm^7cm×4cm。结果10例皮瓣完全成活,3例皮瓣大部分成活,边缘部分坏死,1例经换药后结痂愈合,2例行植皮治疗。术后皮瓣表现为皮色由紫红色变为暗红色最后接近正常皮色,皮瓣边缘会有不同程度的瘀斑形成;皮瓣切口渗血由暗红色变为鲜红色;早期皮瓣肿胀明显,后期肿胀消退。术后随访6~32个月,平均16个月,创面愈合良好,皮瓣与周围组织界限清晰,质地柔软。结论动脉和静脉完全换位在游离皮瓣移植后出现顽固性动脉危象时可作为一种备选方案,挽救皮瓣,减少对患者的创伤。

ObjectiveTo explore the clinical effect of complete transposition of arteriovenous in free flap artery crisis. MethodsFrom October, 2009 to April, 2017, 13 cases of extremities tissue defect were repaired with free flaps. The intractable arterial crisis appeared after transplantation. Repeated anastomosis vessels were adapted but it was not relieved. Then the complete transposition of arteriovenous was adapted in the flaps. Namely the vein of the flap was anastomosed with the arterial in the recipient site to reconstruct the blood supply, and the arterial of the flap was anastomosed with the vein in the recipient site to reconstruct recirculation. Ten cases of hand defect and 3 cases of crus defect were repaired by 5 low abdominal flaps and 8 anterolateral thigh flaps. The tissue defect area was 16 cm×7 cm-6 cm×4 cm and the flap area was 18 cm×8 cm-7 cm×4 cm. ResultsTen flaps survived completely, the other 3 flaps almost survived that scab healed in 1 case and skin grafted in 2 cases. The flap for skin color was from purple red to dark red, and finally close to normal, and skin flap edge would have different degrees of ecchymosis; the bleeding from the incision of the skin flap was from dark red to bright red; the swelling of the flap was obvious in the early stage and the later swelling subsided. All cases were followed-up from 6 months to 32 months with an average of 16 months. The wounds healed well. The flaps had a clear boundary and soft texture. ConclusionComplete transposition of the arteriovenous system can be used as an alternative in the presence of intractable arterial crisis after free flap transplantation, to save the flap and to reduce the trauma to the patient.