游离皮瓣的血管处理：264例股前外侧皮瓣的回顾性研究

How to deal with the vessel of free flap： A retrospective study of 264 cases of anterolateral thigh flap

目的比较吻合2条静脉和吻合1条静脉的游离股前外侧皮瓣移植在头颈部缺损修复中的可靠性和应用价值。方法收集2013年1月至2013年9月之间，在中南大学湘雅二医院口腔颌面外科住院，进行了股前外侧肌皮瓣修复的病人260例（264块皮瓣）。随机将260例患者分为2组：实验组，138例患者（140块皮瓣），吻合1条动脉、1条静脉；对照组，122例患者（124块皮瓣），吻合1条动脉、2条静脉。结果264块皮瓣成活259块，坏死5块，成活率98．1％。实验组发生静脉危象6例，抢救成功4例；对照组发生静脉危象5例，抢救成功2例。两组的静脉危象发生率、抢救成功率的差异均无统计学意义（P〉0．05）。两组均未发生动脉危象。实验组的显微操作时间为18—101min，平均47min；对照组为45—133rain，平均71min，两组间的差异有统计学意义（P=0．0003）。结论只吻合1条静脉、1条动脉可能并不会显著降低游离股前外侧皮瓣的成活率，但可以显著缩短显微操作时间。

Objective To compare the reliability and effectiveness of anterolateral thigh flap with double vein anastomosis or one vein anastomosis for reconstruction of head and neck defects. Methods Two hundred and sixty four cases of anterolateral thigh flap transfers for head and neck reconstruction from January, 2013 to September, 2013 in the Second Xiangya Hospital of Central South University were reviewed. 260 patients were randomly divided into 2 groups. In the experimental group, there were 138 patients 140 cases of anterolateral thigh flap with one vein one artery anastomosis. In the control group, there were 122 patients 124 cases of anterolateral thigh flap with double vein one artery anastomosis. Results Among 264 anterolateral thigh flaps, the overall success rate of free flap was 98.1% （259/264）, 5 free flaps were lost. In the experimental group, there were 6 free flaps occurred venous thrombosis, two of them were lost. In the control group, there were 5 cases occurred venous thrombosis, three of them were lost. No arterial thrombosis occurred in both groups. The time of micromanipulation was 18 to 101 rain, with the average of 47 min in the experimental group. In the control group, the time was 45 to 133 rain, with the average of 71 min. （P= 0.0003）. Conclusion Anterolateral thigh flap with one vein one artery anastomosis for head and neck reconstruction did not affect the survival rate but it can absolutely reduce the operation time.