摘要
目的探讨腓肠神经营养血管皮瓣修复足跟部软组织缺损时,皮瓣远端局部应用低分子肝素预防静脉危象的发生,提高皮瓣成活质量的临床方法。方法 32例腓肠神经营养血管皮瓣修复足跟部软组织缺损,16例皮瓣术后给予常规显微外科护理作为对照组,16例皮瓣在显微外科护理基础上,皮瓣远端小隐静脉断端处留置一枚静脉留置针(Vasofix-R)20-24G,通过该留置针每4小时给予0.1ml,500AXa IU低分子肝素钙,连续5d,作为试验组。比较2组皮瓣静脉危象发生及皮瓣肿胀情况。术后第6天复查血常规、凝出血常规评定低分子肝素对全身的影响。结果对照组皮瓣有不同程度的肿胀,皮瓣远端出现静脉危象5例(31.25%),其中4例皮瓣远端出现深层坏死。试验组出现静脉危象仅1例(6.25%),经抢救处理,皮瓣均成活,无明显肿胀,且所有患者凝出血检查未见异常改变。结论局部应用低分子肝素可预防腓肠神经营养血管皮瓣静脉危象的发生,提高皮瓣的成活质量,对全身影响较小。
Objective To evaluate the effect of low- molecular- weight heparin in the small saphenous vein of the ditally- based fascial flap to reduce venous congestion and increase flap survival quality. Methods 32 patients were treated with sural neurovascular flap for coverage of wounds of heel. The patients were randomly divided into control groups（ n = 16）and experimental group（ n = 16）. Conventional treatment was given to the patients in control group,while in experimental group there was a venous indwelling needle（ Vasofix- R） in the small saphenous vein end 0. 1ml（ 500 AXa IU） low- molecular- weight heparin was used each 4h by the needle in the vein for 5 days. Blood circulation of the flap was observed. The Hb before and after the operantion was observed in the 6th day. Then compared the postoperative healing situation of the patients from the two groups. Results There was 1 case with venous congestion in experimental group,however 5 cases in control group,of which there were 4 cases with partial necrosis. The difference of flap necrosis rate between two groups was not signigicant. The Hb before the operation and after the operantion 6 days was no difference in two groups（ P 0. 05）. Conclusion The application of low molecular weight heparin can alleviate the swelling of the flap and increase the quality of flap survival to release venous congestion for the flaps.
出处
《临床合理用药杂志》
2016年第8期11-13,共3页
Chinese Journal of Clinical Rational Drug Use
关键词
腓肠神经营养血管皮瓣
低分子肝素
软组织缺损
Sural neurocutanious vascular flap
Low-molecular-weightheparin
Heel tissue defect
