血管化锁骨上窝淋巴结皮瓣移植治疗肢体淋巴水肿近期疗效

Short-term outcome of vascularized supraclavicular lymph nodes flap transplantation to treat the lower extremity lymphedema

目的探讨通过血管化锁骨上窝淋巴结皮瓣移植治疗下肢淋巴水肿的近期疗效。方法2014年6月至2016年6月．采用右侧血管化锁骨上窝淋巴结皮瓣游离移植治疗Ⅱ，Ⅲ期下肢淋巴水肿6例．皮瓣大小2．5cm×8．0cm～3．5cm×10．0cm．受区选择在足背侧，受区血管为胫前动脉及伴行静脉。术后进行随访。结果1例术后1d皮瓣坏死，改用淋巴管静脉吻合术；2例术后出现静脉危象，血管探查重新吻合静脉，皮瓣部分坏死，淋巴结成活，植皮闭合创面：其余3例移植皮瓣顺利成活。随访0．5～2．0年．患侧大腿及小腿周径分别减少1．0～6．5cm，术后未出现淋巴管炎发作．供区未发现并发症。结论应用血管化锁骨上窝淋巴结皮瓣移植治疗肢体淋巴水肿近期疗效较好．无明显并发症．是早、中期的下肢淋巴水肿可选择的治疗方法之一。

Objective To investigate the short-term outcome of vascularized supraclavicular lymph nodes flap transplantation to treat the lower extremity lymphedema. Methods From June, 2014 to June, 2016, 6 cases of stage Ⅱ-Ⅲ lower extremity lymphedema received vascularized supraclavicular lymph nodes flap transplantation in this study. Flap size ranged from 2.5 cm×8.0 cm to 3.5 cm×10.0 cm. The anterior tibial artery and accompanying vein were detached for anastomosis. Results One case suffered flap necrosis and then received lymphatic-venous anastomosis instead; 2 cases suffered vascular crisis and partial flap necrosis, but transplanted lymph node survived and the wound were closed with skin graft. The other 3 flaps survived without any complication. Follow-up time ranged from 0.5 to 2.0 years. The affected limb circumference and the incidence of lymphangitis decreased significantly, with no complications observed in donor site. Conclusion Using vascularized supraclavicular lymph nodes flap transplantation to treat low- er limb lymphedema, it has satisfactory short-term outcome and no obvious complications. It is a promising treatment choice for patients with lower extremity lymphedema in the early and mid stage.