穿支皮瓣术后标记系统设计及临床应用

Design and clinical application of postoperative marker system of perforator flap

目的探讨基于穿支皮瓣解剖的术后标记系统设计方案及临床应用效果。方法本文的术后标记系统指根据穿支皮瓣的基本解剖结构及血供特点，于术后在皮瓣表面及受区标记各观察点，并根据标记的测听点，配合使用手持式多普勒血流探测仪测听，以及以穿支点为中心的钟面测量血供观察法，对皮瓣血供进行观察、判断。自2015年11月至2017年11月，对在行穿支皮瓣手术患者200例进行前瞻性研究.其中100例用单纯传统血运观察（传统血运观察组）、100例用传统血运观察和术后标记系统监测（联合观察组），比较两组在术后血管危象发生率、准确率、手术探查率以及皮瓣成活率的差异。结果传统血运观察组和联合组患者术后血管危象多集中于术后48h内，两组手术患者血管危象发生率、阳性率、阴性率差异均无统计学意义（P〉0.05）：传统血运观察组血管危象手术探查率（87.5％）高于联合组（27.8％），差异有统计学意义（P〈0.05）：联合组皮瓣成活率（99％）高于传统血运观察组（90％），差异有统计学意义（P〈0.05）。结论本文提出的穿支皮瓣术后标记系统简单易行，能够有效指导皮瓣血供观察，及时发现并判断血管危象并指导非手术有效干预，提高穿支皮瓣成活率。

Objective To investigate the design of the postoperatively marker system based on the perforator flap and its clinical application. Methods According to the basic anatomy and blood supply characteristics of perforator flap, the observation points were marked on the flap surface and recipient area postoperatively, and judge flap blood flow changes with hand-held Doppler（HHD） and clock-face measurement based on perforators. From November, 2015 to November, 2017, prospectively conducted a control study evaluating the incidence of vascular crisis, accuracy rate, reoperation rate and survival rate of flaps between simple traditional flap monitoring group （n=100） and traditional flap monitoring combine with postoperatively marker system monitoring group （n=100）. Results Vascular crisis was mostly concentrated with in 48 h postoperative in traditional flap monitoring group and combined group. There was no significant difference in the incidence, positive rate and negative rate of vascular crisis in the two groups （P〉0.05）. The reoperation rate in the traditional flap monitoring group （87.5%） was higher than the combined group （27.8%）（P〈0.01）. The survival rate of flap of combined group （99%） was higher than the traditional falp monitoring group （90%） （P〈O.05）. Conclusion The postoperatively marker system of perforator flap can effectively guide the medical staff to observe the blood supply of the flap, detect and judge the vascular crisis in time, and It is simple and easy to do without increasing the patient＇s trauma and medical expenses as well as no additional equipments.