股前外侧皮瓣修复颌面部缺损失败原因分析及预防和处理措施

Analysis of Necrotic Complications of Anterolateral Thigh Free Flap in Reconstructive Surgery of the Face

目的 :分析股前外侧皮瓣坏死的原因及有效预防和处理措施。方法 :回顾分析我院2011-01—2015-12期间,54例股前外侧皮瓣游离移植修复颌面部缺损的临床病例中,失败病例的详细资料,寻找可能导致游离股前外侧肌皮瓣坏死的原因。结果:54例股前外侧皮瓣修复病例中有12例发生坏死,其中有2例全部坏死,10例部分坏死;1例因术中发现股前外侧皮瓣供血动脉发生变异,导致皮瓣全部坏死,1例因术后发生血管危象抢救失败导致全部坏死,其余10例部分坏死病例中,9例为静脉性栓塞,1例为动脉性栓塞,经重新打开吻合血管清除血栓后部分存活。在经处理后皮瓣存活的病例中,6例伴有糖尿病,血糖波动明显,2例为高血压,血管粥样硬化明显,2例为放疗后患者。结论:术前积极处理基础疾病,熟悉股前外侧皮瓣的走形,术中熟练掌握吻合血管技巧,术后仔细观察和护理,是减少股前外侧皮瓣坏死的重要措施。

Objective： To analyze the aetiology and pathogenesis of necrotic complications of anterolateral thigh free flap in reconstructive plastic surgery of the face, and its preventive measures. Methods： A retrospective analysis was conducted on patients reporting to our hospital. A total of 54 consecutive patients from December 2015 to January 2011 were included. Results： 12 cases of necrotic complications presented in the anterolateral thigh free flaps（12/54=22.2%）,of which 2 cases were total necrosis, and 10 cases were partial necrosis. After further analysis, in 1 case, the blood supply artery of the anterolateral femoral flap was found to be variant, which resulted in the total necrosis of the flap; the other case with postoperative vascular crisis lead to failure. The remaining 10 cases showed partial necrosis, 9 cases caused by venous thrombosis, 1 case caused by arterial embolism with partial survival after rescue measures. Among the 10 cases, 6patients were accompanied with diabetes mellitus and significant fluctuations in blood glucose levels, 2 patients suffered with atherosclerotic hypertension. 2 patients were treated with radiotherapy. Conclution： Thorough examination and active treatment of the underlying diseases of the donors before transplantation surgery, is an important measure to reduce the necrosis risks.