小隐静脉三种处理方案对下肢远端皮肤软组织缺损合并骨关节外露患者皮瓣存活的影响
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摘要
目的:比较三种不同小隐静脉处理方案对下肢远端皮肤软组织缺损合并骨关节外露患者皮瓣存活情况的影响。方法:选取2008年1月-2017年1月笔者医院烧伤外科收治的180例因电击伤或热挤压伤手术扩创后出现下肢远端皮肤软组织缺损合并骨关节外露患者,按照对小隐静脉处理方式的不同分为对照组,结扎组及吻合组,每组60例。所有患者均采用腓肠神经营养血管皮瓣进行修复皮肤缺损。对照组于皮瓣近端将腓肠神经及小隐静脉离断并结扎;结扎组在对照组基础上于皮瓣蒂的小隐静脉起始处结扎;吻合组将小隐静脉与受区相应静脉进行吻合。观察三组患者手术前后IL-6、TNF、LPS等炎症指标变化情况,比较三组患者术后皮瓣坏死发生率和皮瓣肿胀及青紫发生情况。结果:三组患者术后14d IL-6、TNF、LPS炎症因子水平较术前均有所改善,且结扎组与吻合组术后14d IL-6、TNF、LPS炎症因子水平均低于对照组,差异有统计学意义(P<0.05);吻合组与结扎组比较,差异无统计学意义(P>0.05)。结扎组与吻合组术后皮瓣肿胀及青紫发生率、皮瓣肿胀及青紫持续时间、皮瓣坏死率均优于对照组,差异有统计学意义(P<0.05);吻合组与结扎组比较,差异无统计学意义(P>0.05)。结论:对于电击伤或热挤压伤所致下肢远端皮肤缺损伴骨关节外露患者,术中通过结扎小隐静脉起始处或将小隐静脉与受区静脉网吻合能够取得较为满意的临床疗效,提高皮瓣存活率。
Objective To compare the effects of three different small saphenous vein treatments on patients with distal skin and soft tissue combined with exsertion of bone and joint caused by an electric or hot crush wound. Methods From January 2008 to January 2017,180 cases in our hospital with skin and soft tissue defect of distal lower extremity with exsertion of bone and joint caused by an electric or hot crush wound were divided into the control group,the ligation group and the anastomosis group,60 cases in each group. All patients were treated with gastrocnemius vascular flap to repair the skin defect.In the control group, the sural nerve and the small saphenous vein were severed and ligated at the proximal end of the flap.The ligation group was ligated at the beginning of the small saphenous vein pedicled with the flap on the basis of the patients in the control group.In the anastomosis group, the small saphenous vein was anastomosed with the corresponding vein in the recipient area.The inflammatory indexes such as IL-6, TNF, LPS were observed before and after the operation of three groups of patients. The swelling of skin flaps and the occurrence of blue-violet and skin flap necrosis were observed. Results The levels of inflammatory factors IL-6, TNF and LPS were improved after operation in the three groups, and the levels of IL-6, TNF and LPS in the ligation group and the anastomosis group were lower than those in the control group, the differences were statistically significant(P <0.05). There was no significant difference between the anastomosis group and the ligation group(P >0.05). The flap swelling and cyanosis incidence, flap swelling and cyanosis duration, skin flap necrosis rate in the ligation group and the anastomosis group were better than those in the control group(P <0.05). There was no significant difference between the anastomosis group and the ligation group(P >0.05). Conclusion For patients with distal skin defect of lower extremity caused by electric shock injury or hot crush injury with exsertion of bone and joint, ligating the small saphenous vein at the beginning or anastomosis of the small saphenous vein with the recipient venous network during the surgery can obtain satisfactory clinical results,increase the survival rate of skin flap.
Objective To compare the effects of three different small saphenous vein treatments on patients with distal skin and soft tissue combined with exsertion of bone and joint caused by an electric or hot crush wound. Methods From January 2008 to January 2017,180 cases in our hospital with skin and soft tissue defect of distal lower extremity with exsertion of bone and joint caused by an electric or hot crush wound were divided into the control group,the ligation group and the anastomosis group,60 cases in each group. All patients were treated with gastrocnemius vascular flap to repair the skin defect.In the control group, the sural nerve and the small saphenous vein were severed and ligated at the proximal end of the flap.The ligation group was ligated at the beginning of the small saphenous vein pedicled with the flap on the basis of the patients in the control group.In the anastomosis group, the small saphenous vein was anastomosed with the corresponding vein in the recipient area.The inflammatory indexes such as IL-6, TNF, LPS were observed before and after the operation of three groups of patients. The swelling of skin flaps and the occurrence of blue-violet and skin flap necrosis were observed. Results The levels of inflammatory factors IL-6, TNF and LPS were improved after operation in the three groups, and the levels of IL-6, TNF and LPS in the ligation group and the anastomosis group were lower than those in the control group, the differences were statistically significant(P <0.05). There was no significant difference between the anastomosis group and the ligation group(P >0.05). The flap swelling and cyanosis incidence, flap swelling and cyanosis duration, skin flap necrosis rate in the ligation group and the anastomosis group were better than those in the control group(P <0.05). There was no significant difference between the anastomosis group and the ligation group(P >0.05). Conclusion For patients with distal skin defect of lower extremity caused by electric shock injury or hot crush injury with exsertion of bone and joint, ligating the small saphenous vein at the beginning or anastomosis of the small saphenous vein with the recipient venous network during the surgery can obtain satisfactory clinical results,increase the survival rate of skin flap.
引文
[1]任鹏,程二林,阿不来提·阿不拉,等.选择不同供血方式的小腿后外侧带蒂皮瓣修复足踝部皮肤软组织缺损[J].中华显微外科杂志,2016,39(5):452-456.
[2]付立策,杨瑞甫.不同供血方式的小腿后外侧带蒂皮瓣修复足踝部皮肤软组织缺损效果研究[J].中国美容医学,2017,26(10):43-46.
[3]孙强,郭澍,王迪,等.腓肠神经营养血管皮瓣修复外伤性小腿及足部骨外露:15例临床报告[J].临床军医杂志,2016,44(9):966-969.
[4]杨宇,仇雄文,郑清健,丁力,郑胜武,林根辉,庄兢,黄雄梅.增加皮肤蒂的改良逆行腓肠神经营养血管皮瓣在跟腱外露中的应用[J].中国美容医学,2017,26(7):5-7.
[5]招健明,吴业坤,冯运垒,等.吻合小隐静脉低旋转点腓肠神经营养血管皮瓣修复足部软组织缺损[J].中华显微外科杂志,2014,37(2):199-200.
[6]侯俊杰,杨欣,马勇光,等.腓肠神经小隐静脉筋膜皮瓣在足踝区皮肤软组织缺损修复中的应用[J].组织工程与重建外科杂志,2017,13(3):139-142.
[7]Masquelet AC,Romana MC,Woif G.Skin island flape supplied by the vascular axis of the sensitive superficieal nerve:anatomic study and clinical Experience in the leg[J].Plast Reeonstr Surg,1992,89(6):1115-1121.
[8]刘承伟,刘福尧,邱冰,等.切取阔筋膜的股前外侧皮瓣在足踝皮肤肌腱缺损中的应用[J].中华显微外科杂志,2015,38(4):382-383.
[9]熊竹友,李光早,张莉,等.腓肠外侧神经-小隐静脉血管蒂皮瓣的解剖学观察与临床应用[J].中华医学美学美容杂志,2013,19(1):24-26.
[10]陆定贵,彭维波,班锦东,等.保留蒂部皮肤浅静脉皮瓣修复足踝部皮肤缺损的临床效果[J].广西医学,2017,39(8):1254-1256.
[11]陈轶强,卢奇昊,孙斐予,等.观察手外伤软组织缺损修复应用不同皮瓣修复术治疗效果[J].湖南师范大学学报(医学版),2015,12(5):88-90,91.
[12]姜平,陈其庆,胡振富,等.分区预扩张颈浅动脉蒂颈肩背皮瓣修复面部大面积缺损[J].中华整形外科杂志,2016,32(1):39-42.
[13]刘贵江,袁敏.皮瓣修复足跟部皮肤软组织缺损的研究进展[J].组织工程与重建外科.2013,9(6):357-360.
[14]Zhang FH,Lin SQ,Song Y,et al.Distally based neurolesser saphenous veno-fasciocutaneous compound flap with a low rotation point[J].Ann Plast Surg,2009,62(4):395-404.
[15]Oberlin C,Azoulay B,Bhatia A.The posterolateral malleolar flap of the ankle:a distally based sural neurocutaneous flap.Report of 14cases[J].Plast Reconstr Surg,1995,96(2):400-405.
[16]Horn D,Jonas R,Engel M,et a1.A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region[J].J Craniomaxillofac Surg,2014,42(8):1551-1556.
[2]付立策,杨瑞甫.不同供血方式的小腿后外侧带蒂皮瓣修复足踝部皮肤软组织缺损效果研究[J].中国美容医学,2017,26(10):43-46.
[3]孙强,郭澍,王迪,等.腓肠神经营养血管皮瓣修复外伤性小腿及足部骨外露:15例临床报告[J].临床军医杂志,2016,44(9):966-969.
[4]杨宇,仇雄文,郑清健,丁力,郑胜武,林根辉,庄兢,黄雄梅.增加皮肤蒂的改良逆行腓肠神经营养血管皮瓣在跟腱外露中的应用[J].中国美容医学,2017,26(7):5-7.
[5]招健明,吴业坤,冯运垒,等.吻合小隐静脉低旋转点腓肠神经营养血管皮瓣修复足部软组织缺损[J].中华显微外科杂志,2014,37(2):199-200.
[6]侯俊杰,杨欣,马勇光,等.腓肠神经小隐静脉筋膜皮瓣在足踝区皮肤软组织缺损修复中的应用[J].组织工程与重建外科杂志,2017,13(3):139-142.
[7]Masquelet AC,Romana MC,Woif G.Skin island flape supplied by the vascular axis of the sensitive superficieal nerve:anatomic study and clinical Experience in the leg[J].Plast Reeonstr Surg,1992,89(6):1115-1121.
[8]刘承伟,刘福尧,邱冰,等.切取阔筋膜的股前外侧皮瓣在足踝皮肤肌腱缺损中的应用[J].中华显微外科杂志,2015,38(4):382-383.
[9]熊竹友,李光早,张莉,等.腓肠外侧神经-小隐静脉血管蒂皮瓣的解剖学观察与临床应用[J].中华医学美学美容杂志,2013,19(1):24-26.
[10]陆定贵,彭维波,班锦东,等.保留蒂部皮肤浅静脉皮瓣修复足踝部皮肤缺损的临床效果[J].广西医学,2017,39(8):1254-1256.
[11]陈轶强,卢奇昊,孙斐予,等.观察手外伤软组织缺损修复应用不同皮瓣修复术治疗效果[J].湖南师范大学学报(医学版),2015,12(5):88-90,91.
[12]姜平,陈其庆,胡振富,等.分区预扩张颈浅动脉蒂颈肩背皮瓣修复面部大面积缺损[J].中华整形外科杂志,2016,32(1):39-42.
[13]刘贵江,袁敏.皮瓣修复足跟部皮肤软组织缺损的研究进展[J].组织工程与重建外科.2013,9(6):357-360.
[14]Zhang FH,Lin SQ,Song Y,et al.Distally based neurolesser saphenous veno-fasciocutaneous compound flap with a low rotation point[J].Ann Plast Surg,2009,62(4):395-404.
[15]Oberlin C,Azoulay B,Bhatia A.The posterolateral malleolar flap of the ankle:a distally based sural neurocutaneous flap.Report of 14cases[J].Plast Reconstr Surg,1995,96(2):400-405.
[16]Horn D,Jonas R,Engel M,et a1.A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region[J].J Craniomaxillofac Surg,2014,42(8):1551-1556.