摘要
目的探讨穿支皮瓣游离移植术后出现淤血危象的病因、程度和分型方法，总结相应的救治策略和临床疗效。方法采用回顾性病例系列研究分析2006年1月-2015年12月行穿支皮瓣游离移植术后出现皮瓣淤血危象187例患者的临床资料，其中男128例，女59例；年龄9—68岁，平均41．3岁。根据皮瓣出现瘀斑的范围、特点及其进展速度的不同，将皮瓣淤血危象分为四型：1型（代偿型），2型（局部瘀斑型），3型（散在瘀斑型），4型（瘀斑进展型）。非手术治疗淤血危象109例（1型37例，2型68例，3型4例）。行手术探查78例（3型35例，4型43例），术中发现静脉回流受阻35例（45％），均为4型；动脉供血不足29例（37％），均为3型；动、静脉同时受阻14例（18％），包括3型6例、4型8例。观察非手术治疗和手术探查皮瓣的存活、坏死情况。结果非手术治疗后完全存活皮瓣94例（86．2％），浅层部分坏死13例（11．9％），完全坏死2例（1．8％）。手术探查并解除各自静脉、动脉、动静脉受阻因素后，皮瓣完全存活分别为29例（83％）、17例（59％）和8例（57％）；部分坏死分别为4例（11％）、3例（10％）和4例（29％）；完全坏死分别为2例（6％）、9例（31％）和2例（14％）。本组132例患者获得随访3-21个月，平均8．7个月。与无危象皮瓣相比，非手术或手术治疗完全存活的淤血皮瓣质地和色泽未见明显改变；经再次植皮或逐步脱痂愈合的淤血皮瓣质地偏硬，色泽偏暗。结论皮瓣术后静脉回流受阻或动脉供血不足均可促使静脉血在皮瓣内淤积。游离穿支皮瓣淤血危象分型区分标准客观，能协助术者明确皮瓣淤血的原因和程度，利于危象的早期正确诊治。1、2型非手术治疗效果明显；3、4型尽早行手术探查可提高挽救淤血危象皮瓣的成功率。
Objective To investigate the causes, degree and classification of congestion crisis following free perforator flap transplantation and summarize the related treatment strategies and clinical efficacy. Methods A retrospective case series study was made on 187 cases of congestion crisis after free perforator flap transfer from January 2006 to December 2015. There were 128 males and 59 females, with a mean age of 41.3 years（range, 9-68 years）. Based on the area, characteristics, and progress of ecchymosis showing on the flap surface, the flap congestion was divided into type 1 （ compensation type）, type 2 （limited petechiae type）, type 3 （ scattered petechiae type） and type 4 （ progressive petechiae type）. Conservative treatments were applied to 109 cases including 37 cases of type 1, 68 type 2 and 4 type 3. Other 78 cases including 35 cases of type 3 and 43 type 4 underwent surgical revision. After exploration, 35 cases （45%） of type 4 were due to venous obstruction, 29 cases （37%） of type 3 due to arterial occlusion, and 14 cases （18%） consisting of 6 type 3 and 8 type 4 due to both arterial and venous obstruction. Flap survival or necrosis was detected after treatments. Results After conservative treatment, the flaps showed complete survival in 94 cases （86. 2% ）, superficial partial necrosis in 13 （11.9%） and complete necrosis in 2 （1. 8% ）. After surgical revision, the flaps with venous obstruction showed complete survival in 29 cases （83%）, partial necrosis in 4 （ 11% ） and complete necrosis in 2 （6%）, the flaps with arterial obstruction showed complete survival in 17 cases （59%）, partial necrosis in 3 （ 10% ） and complete necrosis in 9 （31%）, and the flaps with both venous and arterial obstruction showed complete survival in 8 cases （57%）, partial necrosis in 4 （29%） and complete necrosis in 2 （14%）. A total of 132 patients were followed up for 3-21 months （mean, 8.7 months）. Texture and color of the fully salvaged flaps were
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2017年第2期111-117,共7页
Chinese Journal of Trauma
基金
浙江省自然科学基金（LY13H060008）
宁波市自然科学基金（2015A610312,2016A610012）
关键词
软组织损伤
外科皮瓣
穿支皮瓣
Soft tissue injuries
Surgical flaps
Perforator flaps
