游离组织瓣治疗无吻合血管或需困难吻合血管创面的临床进展

Clinical advances in free tissue flaps for the treatment of wounds without anastomotic vessels or requiring difficult anastomotic vessels

无或需困难吻合血管创面是由创伤、肿瘤、手术及放射性治疗后损伤等多种病因导致的一种较难修复的复杂性创面。此类创面由于受区血管缺如,常规方法很难修复,故如何建立受区可用于吻接游离组织瓣的血管是问题的关键。临床中常用的构建受区吻接血管的解决方案主要有3大类:一是血管束移植包括自体静脉和人工血管,二是桥式交叉皮瓣移植术,三是Flow-through皮瓣。在建立了受区吻接血管后,可为游离皮瓣、肌瓣、筋膜瓣、大网膜瓣等治疗方法修复创面奠定基础,从而治愈疾病。本文将综述无或需困难吻合血管创面特点和现有解决方案,希望能为临床解决此类问题提供决策和治疗依据。

The wound without or with difficulties in vascular anastomosis is a kind of complex wounds caused by trauma,tumor,operation,radiation therapy,and other causes.The lack of blood vessels in the recipient area makes it challenging to repair wound using conventional methods.Therefore,establishing new blood vessels that can support free tissue flap transfer is crucial.Surgeons employ various solutions to construct anastomotic vessels in the recipient area,including vascular bundle transplantation,which may involve autogenous vein or artificial blood vessels,cross-crossing leg-free skin flaps,flow-through flaps,and end-to-patch anastomosis.Once established,these anastomotic vessels serve as a foundation for therapeutic approaches such as free skin flap,muscle flap,fascia flap,greater omentum flap,and other methods used to repair wounds and cure diseases.This article reviews the characteristics and existing solutions of vascular anastomosis without or with difficulties,aiming to provide with such challenges.It clinical decision-making and treatment strategies for surgeons faced underscores the importance of establishing new blood vessels in the recipient area to support free tissue flap transfer and highlights the clinical techniques utilized to achieve successful outcomes.