动脉端端吻合与端侧吻合法在旋髂浅动脉浅支穿支皮瓣移植中的应用

Application of arterial end-to-end and end-to-side anastomosis in superficial branch of the superficial circumflex iliac artery perforator flap transfer

目的对比探讨动脉端端吻合与端侧吻合法在旋髂浅动脉(SCIA)浅支穿支皮瓣移植中应用的效果。方法2019年11月至2020年12月,应用SCIA浅支穿支皮瓣修复四肢创面21例,皮瓣切取面积为3.5 cm×7.0 cm~9.0 cm×18.0 cm。根据受区主干动脉上壁或前壁有无与皮瓣动脉匹配的分支,分为2组。端端吻合组:皮瓣动脉与受区主干动脉分支端端吻合10例;端侧吻合组:皮瓣动脉与受区主干动脉端侧吻合11例。皮瓣静脉与受区主干动脉的伴行静脉端端吻合,皮瓣供区直接缝合。术后门诊随访6个月~1年,观察皮瓣成活情况、皮瓣及供区的外形和功能。两组数据进行统计学分析,P<0.05为差异有统计学意义。结果端端吻合组10例皮瓣全部成活;端侧吻合组11例皮瓣有2例发生静脉危象,探查见静脉血栓形成,动脉端侧吻合口血流通畅,无栓塞,1例重新吻合静脉后成活,1例再次静脉危象时改腹部带蒂皮瓣。术后随访6个月~1年,两组皮瓣及供区的外形和功能无差异。SCIA浅支动脉口径、受区动脉分支或侧口口径两组差异无统计学意义(P>0.05),端端吻合组吻合时间(16.70±1.34)min,短于端侧吻合组吻合时间(23.73±1.68)min,差异有统计学意义(P<0.01)。结论在SCIA浅支穿支皮瓣移植中,如果受区主干动脉上壁或前壁有与皮瓣动脉匹配的分支,皮瓣动脉首选与其端端吻合,因无需侧口制作,操作更熟练,吻合时间短;否则与受区主干动脉行端侧吻合。

Objective To explore a comparative study of arterial end-to-end and end-to-side anastomosis in superficial branch of the superficial circumflex iliac artery(SCIA)perforator flap transfer.Methods Between November,2019 and December,2020,21 patients with the soft tissue defects in the limbs were repaired with superficial branch of the SCIA perforator flaps.The size of flaps ranged from 3.5 cm×7.0 cm to 9.0 cm×18.0 cm.According to the upper or anterior wall of the main artery in the recipient area having branches that matched the flap artery,2 groups were established.End-to-end group:10 cases were anastomosed end-to-end between the flap artery and branch of the main artery in the recipient area;End-to-side group:11 cases were anastomosed end-to-side between the flap artery and side mouth of the main artery in the recipient area.The vein of flap was anastomosed end-to-end with the accompanying vein to the main artery in the recipient area.All of the donor sites were sutured directly.All patients were followed-up for 6-12 months and the survival of the perforator flap,the appearance and function of the perforator flap and the donor site were observed.All data of the 2 groups were conducted statistical analyzed.P<0.05 was statistically significant.Results All 10 flaps in end-to-end group survived successfully.In end-to-side group,2 cases had venous crisis in 11 cases of flaps,the exploration revealed venous thrombosis,and the arterial end-to-side anastomosis had smooth blood flow had embolism.One flap survived after re-anastomosis of the vein,and 1 flap was changed to a pedicled abdominal flap during the re-venous crisis.The postoperative follow-up was 6 months to 1 year.The appearance and function of the flap and donor site were satisfactory,without difference between the 2 groups.The SCIA superficial branch artery caliber,recipient artery branch or lateral caliber was not statistically different between the 2 groups(P>0.05).The time of anastomosis for end-to-end group was[(16.70±1.34)min].It was lower than that of anastomosed end-to-side group[(23.73±1.68)min].The difference was statistically significant(P<0.01).Conclusion In superficial branch of the SCIA perforator flap transfer,if the upper or anterior wall of the main artery in the recipient area has a branch that matches the flap artery,the flap artery should first be anastomosed with its end.Because it dose not required to make a side port,and makes the operation more convenient with a short anastomosis time;Otherwise,perform end-to-side anastomosis with the main artery of the recipient site.