静脉皮瓣移植术后血管危象的原因及处理

Investigation on improving the survival rate of venous flap after transplantation

目的 通过对静脉皮瓣成活机理的研究,探讨血管危象发生的原因及有效处理方法.方法 2009年9月—2013年6月,142例游离静脉皮瓣移植修复手足部皮肤软组织缺损的病例中19例发生血管危象,分析血管危象发生的原因,并总结有效的处理方法. 结果 19例血管危象中,发生静脉吻合口栓塞11例（7.7%）,皮瓣肿胀瘀血3例（2.1%）,血肿压迫血管蒂3例（2.1%）,供血血管压力不足2例（1.4%）,经手术探查或保守处理后皮瓣成活15例（78.9%）. 结论 完善的术前设计,选用较高压力的营养血管,积极预防应对术后血管危象可提高静脉皮瓣的成活率.

Objective To explore how to improve the survival rate of free venous flap after transplantation through the investigation on the survival mechanism. Methods 142 cases of hand or foot soft tissue defect between September 2008 and June 2012 were repaired by free venous flap transplantation. Methods for improving survival rate were sum up by analysing of the causes of necrosis and survival. Results There are 11 cases of venous embolism at anastomotic site （7.7%）, 3 cases of swelling and congestion in the flap （2.1%）, 3 cases of hematoma compression the pedicle （2.1%）, 2 cases of insufficient pressure of blood supply （1.4%） in all cases. 15 cases （78.9%） of them are survival by exploratory operation or conservative treatment. Conclusion It can improve the survival rate of venous flap thougth Perfect preoperative design, using nutrient vessel with high pressure, actively preventing postoperative vascular crisis.