术前应用低分子肝素钙在游离股前外侧皮瓣移植术中的临床价值分析

Analysis of clinical value of preoperative low molecular weight heparin calcium in free anterolateral thigh flap transplantation

目的探讨术前12 h应用低分子肝素钙在游离股前外侧皮瓣移植术中的临床疗效。方法选取50例手、足部皮肤软组织缺损行游离股前外侧皮瓣移植术修复的患者为研究对象,随机分成观察组(26例)和对照组(24例)。观察组术前12 h开始使用低分子肝素钙,术后4 h继续常规使用;对照组术后4 h开始常规使用低分子肝素钙。比较两组术后皮瓣成活率、皮瓣血管危象发生率及术后出血性事件发生率。结果随访3个月后,两组共行游离皮瓣52块,其中2例为双侧股前外侧皮瓣移植。①皮瓣成活率:观察组26例患者中,25例皮瓣全部成活,1例出现皮瓣尖端部分坏死,皮瓣成活率为96.2%。对照组24例患者中,所有皮瓣均成活,未出现皮瓣坏死现象,皮瓣成活率为100.0%。两组皮瓣成活率比较差异无统计学意义(P>0.05)。②血管危象发生率:观察组26例患者均未出现血管危象并探查情况,血管危象发生率为0;对照组1例患者发生2次血管危象,经2次探查后成活,其他23例患者均未发生血管危象,血管危象发生率为4.2%,两组血管危象发生率比较差异无统计学意义(P>0.05)。两组均未发生术后出血性事件。结论术前12 h开始使用低分子肝素钙对比术后4 h开始使用低分子肝素钙对皮瓣成活率、皮瓣血管危象发生率的影响无明显差异,术前12 h或术后4 h开始使用低分子肝素钙均不会增加术后出血性事件发生率。

Objective To discuss the clinical efficacy of low molecular weight heparin calcium 12 h preoperatively in free anterolateral thigh flap transplantation.Methods A total of 50 cases of soft tissue defects of the hand and foot treated with free anterolateral thigh flap transplantation were studied and randomly divided into observation group(26 cases)and control group(24 cases).The observation group was treated with low-molecular weight heparin calcium at 12 h preoperatively,and continued to use routine at 4 h preoperatively,while the control group was treated with low-molecular weight heparin calcium at 4 h postoperatively.The survival rate of the flap,the incidence of vascular crisis and the incidence of postoperative bleeding events were compared.Results After 3 months of follow-up,52 free flaps were performed in both groups,of which 2 cases were bilateral anterolateral femoral flaps.(i)Flap survival rate:of the 26 patients in the observation group,25 flaps were completely alive,and 1 case showed partial necrosis of the tip of the flap,with a flap survival rate of 96.2%.In the 24 patients in the control group,all the flaps survived without flap necrosis,and the flap survival rate was 100.0%.There was no statistically significant difference in flap survival rate between the two groups(P>0.05).(ii)Incidence of vascular crisis:26 patients in the observation group did not have vascular crisis,the incidence of vascular crisis was 0;1 patient in the control group had 2 vascular crises and survived after 2 explorations,and the other 23 patients did not have vascular crises,and the incidence of vascular crisis was 4.2%,and the difference in incidence of vascular crisis between the two groups was not statistically significant(P>0.05).No postoperative bleeding events occurred in either group.Conclusion There are no significant differences in the effects of using low-molecular heparin calcium at 12 h preoperatively versus 4 h postoperatively on flap survival rate and the incidence of vascular crises.The use of low-molecular heparin calcium either 12 h preoperatively or 4 h postoperatively dose not increase the incidence of postoperative bleeding events.