复合组织瓣修复合并静脉功能障碍组织缺损的应用研究

Application of composite tissue flap to repairing tissue defect complicated with venous dysfunction

目的探讨复合组织瓣修复静脉功能障碍的组织缺损的应用价值。方法 12例接受复合组织瓣修复手术患者,均合并有不同程度的静脉功能障碍。通过动脉口吻合,让动脉血流经皮瓣滋养动脉时,在动脉管腔内形成一个压力差,同时皮瓣周缘皮肤与受区皮肤疏松缝合,允许无法通过静脉回流的血液外渗。术后常规皮下注射肝素抗凝治疗,术后120 h可停止皮瓣边缘的肝素外敷抗凝,换药并保证皮瓣切口清洁。结果本组12例皮瓣均全部成活,创面修复良好。皮瓣于术后3 d内瘀紫,无法回流,血液外渗较多,疏松缝合皮肤后,均无须再次拆缝线减压,3 d后皮瓣颜色逐渐转红润,渗出减少,术后10 d皮瓣达到稳定的循环状态。其中Ⅰ期愈合5例,Ⅱ期愈合6例,Ⅲ期愈合1例。1例皮瓣远端部分伤口液化,皮瓣边缘坏死约15%,再次清创缝合后痊愈出院。术后随访6~24个月,平均18个月,创面均恢复良好,修复后肢体外观形态良好,无压痛,肢体功能及外观恢复基本满意。结论复合组织皮瓣修复合并静脉功能障碍患者的组织缺损是安全、有效的手术方式,皮瓣成活率高,可以较好的恢复肢体功能。

Objective To explore the application value of composite tissue flap for repairing tissue defect complicated with venous dysfunction. Methods Twenty patients receiving tissue defect repair with composite tissue flap complicated with different degrees of venous dysfunction. Pressure difference was established in the arterial lumen by anastomosis of artery when arterial blood flew through the flap nutrient artery. And the skin around the flap was loosely sutured with the skin of recipient site in order to extravasated the blood that could not flow back transvenously. Regular subcutaneous injection of heparin was perfoImed after operation. After 120 hours of operation, external anticoagulation with heparin around the flap was discontinued, then the dressing was performed and the incision of the flap should be assured of cleaning. Results Flap survival and well-healed wound were observed in all of the 12 cases. Within 3 days after operation, the flaps turned bruised, the blood could not flow back and quite more blood was extravasated. After loosely suturing the skin, stitches removal and decompression were not necessary in any cases. After 3 days, the color of the flap gradually turned red and exudation decreased. After 10 days of operation, the flap acquired stable circulation. Healing stage I, healing stage Ⅱ and healing stage Ⅲ were observed in 5 cases, 6 cases and 1 cases respectively. In one case, liquefaction was found in some wounds of the distal flap and the necrotic flap edge accounted for about 15%. However, this patients was cured and discharged after another debridement and suturing. All cases were followed up for 6 - 24 months （ average： 18 months）. In all cases, the wounds were healed well, the function and appearance of limbs were good and absence of tenderness, and obtain a satisfied recovery after repairing. Conclusion Repairing tissue defect complicated with venous dysfunction using composite tissue flap is a safe and effective surgical approach, can acquire a high flap survival rate and improve the function of limbs.