吻合远端浅静脉干的带蒂穿支皮瓣修复四肢创面14例

Perforator pedicled flaps by anastomosis of superficial veins for reconstructing the extremity defects： 14 cases report

目的 评价吻合远端浅静脉干对带蒂穿支皮瓣静脉回流的改善和创面修复效果.方法 2012年2月至2013年10月,采用在带蒂穿支皮瓣远端吻合1～2条浅静脉干的方法,修复四肢创面缺损14例,其中骨间后动脉穿支皮瓣5例,尺动脉腕上穿支皮瓣3例,掌背动脉穿支皮瓣2例,腓动脉穿支皮瓣3例,外踝上穿支皮瓣1例.术后观察皮瓣血运、评价肿胀情况;1个月行多普勒血流仪检测静脉吻合口的通畅情况,6 ～12个月问卷调查患者.结果 13例皮瓣完全成活,1例皮瓣远端出现小部分表层坏死,经换药在1个月后愈合;共吻合浅静脉17条,1个月后检查吻合口均通畅;术后7d,皮瓣早期肿胀：Ⅰ度4例,Ⅱ度10例;术后6个月：Ⅰ度11例,Ⅱ度3例.11例获得有效随访,随访时间6～ 12个月,皮瓣外形美观,患者对皮瓣外形均满意. 结论 在带蒂穿支皮瓣远端吻合浅静脉能有效改善其静脉回流,减轻皮瓣的术后肿胀度,且修复效果满意.

Objective To investigate the methods and results of perforator pedicled flaps by anastomosis of superficial veins for reconstructing the extremity defects.Methods From February, 2012 to September, 2012, a total of 14 patients with traumatic skin and soft tissue and artery defects in extremities were repaired by perforator pedicled flaps anastomosed superficial veins with the recipient vessels.Fourteen flaps were based on five kinds of perforator arteries, the posterior interrosseous artery in 5 cases, the ulnar artery in 3 cases, the metacarpal artery in 2 cases, the peroneal artery in 3 cases, the lateral supramalleolar artery in 2 cases, the ulnar artery in 2 cases,and the posterior interrosseous artery in 1 case.After the operation, the blood supplies of flaps were observed severely,postoperative flap swelling were evaluated by edema level classification.After 1 month the blood flow of vein anastomosis were examed by color Doppler ultrasound.Questionnaire of the flap aesthetic satisfactory were performed during fellow-up periods.Results Twelve flaps were all survived well, 2 flaps had partial marginal skin necrosis in the distal, which was managed with surgical debridement, and wound healed in 1 month.Flap swelling were light, edema level classification were one degree in 4 cases,two degree in 10 cases postoperation 7 days, one degree in 11 cases and two degree in 3 cases, after 6 months.Color Doppler ultrasound examinations showed 9 vein anastomosises were all bypassed well.Eleven cases had 6-12 months＇ fellow-up periods.The flaps had like-like appearance, good contour, high aesthetic satisfactory.Conclusion Perforator pedicledr flaps by anastomosis of superficial veins can reduce the flap venous pressure obviously, avoid transientvenous venous congestion, improve the survival quality of the flap.It＇s a safe and effective method for soft tissue coverage of traumatic extremity wounds.