游离皮瓣再手术探查的临床分析

Clinical analysis of surgical re-exploration of free flaps

目的对游离皮瓣再手术探查的原因、处理方法和相关危险因素进行分析和讨论。方法回顾性研究自2015年1月至2016年12月于我科施行的修复四肢皮肤软组织缺损的游离皮瓣病例，从中筛选出曾在皮瓣移植术后再手术探查的病例进行统计分析。结果在126块皮瓣修复四肢皮肤软组织缺损的122例患者中有10例曾行再手术探查，占7．9％。其中男8例，女2例；平均年龄31．4岁。受区为上肢和下肢的皮瓣各5例。术前由于静脉危象探查的8例，其中4例为静脉栓塞，3例出血阻碍静脉回流，1例动静脉错接。其他再探查的原因包括动脉危象1例，皮瓣下出血1例。再探查发生在术后6-57h，平均22．7h。8例皮瓣经探查重新吻合或止血后存活，2例坏死，挽救成功率为80％。结论游离皮瓣再手术探查的主要原因是静脉问题，及时的再手术探查和正确的术中处理对皮瓣的存活十分关键。

Objective To investigate the causes, managements and related risk factors of re-exploration after free flap transplantation. Methods A retrospective study on free flap transplantation for repair of the skin and soft tissue defects of the extremities from January 2015 to December 2016 was conducted. The cases of re-exploration after skin flap transplantation were screened and analyzed. Results In 122 patients with 126 free flaps for repair of skin and soft tissue defects of extremities, 10 cases underwent re-exploration, accounting for 7.9%. There were 8 males and 2 females, with an average age of 31.4 years. There were 5 cases of skin flaps in the upper and lower limbs, respectively. The re-exploration was performed due to venous crisis in 8 flaps including 4 flaps with venous occlusion, 3 flaps with venous compromise by hematoma and 1 flap with mismatching of the artery and vein. The other reasons for re-exploration included arterial crisis in 1 flap and subcutaneous hemorrhage in l flap. The re-exploration occurred at 6 to 57 hours postoperatively, with an average of 22.7 hours. The skin flaps survived after re-anastomosis and hemostasis in 8 cases and died in 2 cases. The success rate of rescue was 80%. Conclusion The main reason for the re-exploration of free flap is venous problems. Timely re- explorations and appropriate intraoperative managements are critical for the survival of skin flaps.