摘要
目的探讨皮瓣重建技术修复因重症下肢缺血行人工血管旁路移植术后人工血管外露的可行性。方法回顾性分析2007年8月至2011年12月诊治的192例下肢人工血管旁路移植术后患者，其中5例（2．6％）在前次术后6～13d发生人工血管外露，包括男性4例，女性1例，年龄52—81岁，中位年龄68岁。外科处理主要包括局部清创及保留移植物的任意皮瓣或肌皮瓣转移修复术，3例应用“Z”形任意皮瓣改形修复，2例采用腹直肌或股直肌皮瓣转移修复。结果4例成功保留了人工血管，切口一期愈合；随访5—57个月，中位随访时问38个月，均未再出现人工血管外露及感染症状，旁路血管通畅；1例术后2周人工血管破裂出血，切除人工血管后因患肢缺血严重行膝上截肢术。结论人工血管外露后果严重，保留血管移植物的任意皮瓣或肌皮瓣修复术是有效的外科处理手段。
Objective To investigate the effectiveness of flap repair for vascular prosthesis exposure after the artificial blood vessel bypass surgery for critical limb ischemia. Methods From August 2007 to December 2011, bypass surgery with vascular prosthetic grafts were performed in 192 patients with critical limb ischemia. Five patients among them （2.6%） suffered from vascular prosthesis exposure 6 to 13 days after the previous surgery, including 4 males and 1 female, with a median age of 68 years （ arranged from 52 to 81 years）. The surgical managements included surgical debridement and local flap or transferred muscle-cutaneous flap repair to preserve the prosthetic vascular grafts. Three patients underwent Z-plasty with local flap repair, while 2 patients underwent transferred rectus abdominis or rectus femoris muscle flap repair of the wounds. Results After the surgery, prosthetic vascular graft was successfully preserved in 4 of the 5 cases with first intention healing. At a median follow-up of 38 months （arranged from 5 to 57 months）, all the 4 limbs were salvaged with patent of the prosthetic grafts. One flap failed to heal and the prosthetic graft had to be removed due to infection and hemorrhage. An above-knee-amputation was performed due to severe limb ischemia. Conclusions The vascular prosthesis exposure is often a disaster after artificial blood vessel bypass surgery for critical limb ischemia Local flap or transferred muscle-cutaneous flap repair is an effective surgical management to salvage the exposed graft and the affected limb.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2013年第8期715-718,共4页
Chinese Journal of Surgery
关键词
动脉硬化
闭塞性
缺血
人工血管
清创术
外科皮瓣
Arteriosclerosis obliterans
Ischemia
Blood vessel prothesis
Debridement
Surgical flaps
