静脉超引流技术在游离皮瓣移植中的应用

Application of venous super drainage technique in free flaps transfer

目的观察在游离皮瓣手术中应用静脉超引流技术的治疗效果.方法2017年6月至2018年12月,共应用游离皮瓣7例,其中旋髂浅动脉皮瓣游离移植1例,第1跖背动脉皮瓣游离移植1例,股前外侧游离皮瓣5例.致伤原因:电击伤1例,肿瘤相关创面2例,深度烧伤1例,机械性创伤2例,坏死性筋膜炎1例.均进行游离皮瓣移植修复,术中根据需要及具体条件进行静脉超引流技术应用,在受区和供区都准备2套静脉通路,形成双套静脉回流的超引流模式.术后观察皮瓣血运、肿胀、渗液、二次探查情况、皮瓣成活率,并定期随访.结果7例皮瓣均顺利成活,术后均无发生动、静脉危象,采用静脉超引流技术的皮瓣术后血运良好、肿胀较轻、渗液较少,水肿消退快,无二次手术探查.术后随访2~18(平均10.5)个月,感染无复发,皮瓣成活良好;供区愈合好,局部感觉无缺失;关节屈、伸活动正常.结论静脉超引流技术在游离皮瓣修复手术血管蒂处理中,为游离皮瓣准备2套静脉系统,有利于减少皮瓣术后的静脉危象,减轻皮瓣水肿,减少渗出,减少二次手术探查,提高皮瓣成活率.

Objective To investigate the effect of venous super drainage applying in free flaps. Methods From June, 2017 to December, 2018, 7 cases who had severe soft tissue injuries were treated with free flap. Cause of injury: 1 electric injuries, 2 tumor-related wounds, 1 deep burns, 2 mechanical trauma, and 1 necrotizing fasciitis. All patients were underwent free flap transplantation. There were 5 cases of anterolateral thigh artery perforator flap, 1 case of superficial circumflex iliac artery perforator flap, and 1 case of first dorsal metatarsal artery perforator flap. The application of venous super-drainage technology was carried out according to needs and specific conditions. Two sets of venous passages were prepared in both recipient and donor site to form a double set of venous reflux super-drainage mode. Blood supply, swelling, exudation, secondary exploration and survival rate of the flap were observed after operation, and regularly followed-up. Results All 7 flaps survived. Venous super drainage technique was applied in 7 cases. No arteriovenous crisis occurred after the operation. The flaps had good blood circulation, slight swelling, less exudation, rapid edema regression and no secondary surgical exploration. Followed-up for 2-18 (average 10.5) months, there was no infection recurred. Flaps survived well, and the donor sites healed well without sensory loss. The flexion and extension function of joint was normal. Conclusion The technique of venous super-drainage prepares 2 sets of venous systems for the free flap in the treatment of vascular pedicle in the free flap repair operation, which is conducive to reducing the venous crisis after flap surgery, reducing flap edema, reducing exudation, reducing secondary surgical exploration and improving the survival rate of the flap.