缺血预处理技术在足踝部严重软组织损伤游离皮瓣移植修复术中的应用价值

Application value of ischemic preconditioning technology in free flap transplantation for severe soft tissue injury of foot and ankle

目的研究缺血预处理技术在足踝部严重软组织损伤游离皮瓣移植修复术中的应用价值。方法选择我科2017年11月至2019年7月收治的20例足踝部软组织皮肤缺损患者为研究对象,采取股前外侧游离皮瓣修复术修复缺损组织,所有患者均采用了异位肢体缺血预处理技术,结合快速康复理念、健康宣教、多模式镇痛、常规抗凝、防血栓、抗血管痉挛、抗感染等对症治疗。分析患者术后移植皮瓣的恢复情况及踝功能的恢复效果。结果所有移植皮瓣全部成活,1例患者因术后伤口引流持续,于术后7 d拔管,21 d拆线,局部无其它表现;1例患者术后第2天皮瓣稍苍白,经对症治疗后症状缓解。其余18例患者皮瓣无坏死发生,皮肤颜色好,不臃肿,弹性好,外形良好。患者术后随访至少1年,AOFAS评价踝关节功能优良率达到85%。结论缺血预处理技术可改善机体微循环血量、提高抗氧应激能力,且对移植皮瓣完全无害,可用于皮瓣移植术后护理,以提高移植皮瓣存活率,降低皮瓣失效或部分坏死发生率。

Objective To study the application value of ischemic preconditioning technology in free flap transplantation for severe soft tissue injury of foot and ankle.Methods Twenty patients with soft tissue skin defects of foot and ankle treated in our department from November 2017 to July 2019 were selected as the research objects.The defect tissues were repaired by anterolateral femoral free flap.All patients adopted ectopic limb ischemic preconditioning technology,and combined with rapid rehabilitation concept,health education,multimodal analgesia,routine anticoagulation,antithrombotic,anti vasospasm,anti-infection and other symptomatic treatment.The recovery of transplanted flap and the recovery effect of ankle function were analyzed.Results All the transplanted flaps survived.Due to continuous wound drainage,one patient was extubated at 7 d and sutured at 21 d after operation,and there was no other local manifestations;one patient was slightly pale on the second day after operation,and the symptoms were relieved after symptomatic treatment.The other 18 patients had no flap necrosis,good skin color,no bloat,good elasticity and good shape.The patients were followed up for at least 1 year,and the excellent and good rate of ankle function evaluated by AOFAS was 85%.Conclusion The ischemic preconditioning technology can improve the body’s microcirculatory blood volume,enhance the ability of anti-oxidative stress,and is completely harmless to the transplanted flap.It can be used for postoperative nursing of flap transplantation,so as to improve the survival rate of transplanted flap and reduce the incidences of flap failure or partial necrosis.