回流静脉吻合数量对游离前臂不倒置静脉皮瓣成活的影响
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摘要
目的探讨回流静脉吻合数量对游离前臂不倒置静脉皮瓣成活及疗效的影响。方法选取2015年9月-2018年2月就诊的31例手部皮肤软组织缺损伴深部组织外露的患者作为研究对象,随机分组,动脉与回流静脉数量比例为1∶1(A组)的14例,1∶2的(B组)12例,1∶3的(C组)5例。均予游离前臂不倒置静脉皮瓣修复创面。皮瓣面积:2.0 cm×2.0 cm～4.5 cm×6.5 cm,术后监测皮瓣肿胀、颜色及成活情况,后期观察皮瓣外形、质地、挛缩程度、皮瓣颜色及感觉恢复情况,用以评估回流静脉吻合数量对游离前臂不倒置静脉皮瓣成活及疗效的影响。结果 31例皮瓣,成活29例,坏死2例。术后1～14 d B、C组瘀肿明显轻于A组,且肿胀持续时间短。成活病例获得3～14个月随访,平均9.5个月。皮瓣外观均无明显臃肿,质地软,19例出现轻～中度挛缩,无重度挛缩病例,18例皮色接近正常,11例较周围皮肤稍暗,有轻度色素沉着;皮瓣感觉恢复:4级0例,3级5例,2级18例,1级6例; 2PD为10～18 mm,平均14 mm。结论游离前臂不倒置静脉皮瓣修复手部创面简单、方便、安全,但需注意根据创面的情况建立适当的动静脉吻合比例,在保证供血的情况下,皮瓣大于9 cm2时,动脉与回流静脉比例1∶2或以上可提高皮瓣的远期成活质量。
Objective To investigate the effect of the amount of reflux vein on the survival and effect of the free forearm no-inverted venous flap. Methods From September 2015 to February 2018 in our hospital 31 cases of hand skin soft tissue defect with deep tissue exposure of patients were enrolled as the research object, The cases were randomly divided into groups, Repair of wound surface with the free forearm no-inverted venous flap. area of 2.0 cm×2.0 cm ～4.5 cm×6.5 cm, the arterial venous ratio was1:1(A group) in 14 cases, 1:2 of the 12 cases(B group), 1:3(group C) 5 cases,The survival rate, swelling degree, color, appearance and texture of the flap were observed after operation. the degree of skin flap contracture, skin color and sensation recovery were observed later, and the influence of arteriovenous ratio on the survival rate and curative effect of free forearm flap was evaluated. Results In 31 cases, there were 29 cases of survival and 2 cases of necrosis. At 1-14 days after operation, the swelling of B and C group was significantly lighter than that in group A, and the duration of swelling was shorter. The survival cases were followed up for 3 months to 14 months, with an average of 9.5 months. The appearance of the flaps were not significantly swollen, soft texture; 19 cases had mild to moderate contracture, no severe contracture; 18 cases of skin color were close to the normal skin, 11 cases of skin color were slightly darker than the surrounding skin, with slight pigmentation; skin flap sensory recovery: 0 cases of grade 4, grade 3 in 5 cases, 18 cases of grade 2,grade 1 in 6 cases, 2 PD for 10 ～18 mm, average14 mm. Conclusion The free forearm no-inverted venous flap is a simple, convenient and safe method to repair hand wound. We should pay attention to establish an appropriate ratio of arteriovenous anastomosis according to the condition of the wound. When the flap is larger than 9 cm2, the ratio of arterial return veins to 1:2 or above can improve the long-term survival quality of the flap.
Objective To investigate the effect of the amount of reflux vein on the survival and effect of the free forearm no-inverted venous flap. Methods From September 2015 to February 2018 in our hospital 31 cases of hand skin soft tissue defect with deep tissue exposure of patients were enrolled as the research object, The cases were randomly divided into groups, Repair of wound surface with the free forearm no-inverted venous flap. area of 2.0 cm×2.0 cm ～4.5 cm×6.5 cm, the arterial venous ratio was1:1(A group) in 14 cases, 1:2 of the 12 cases(B group), 1:3(group C) 5 cases,The survival rate, swelling degree, color, appearance and texture of the flap were observed after operation. the degree of skin flap contracture, skin color and sensation recovery were observed later, and the influence of arteriovenous ratio on the survival rate and curative effect of free forearm flap was evaluated. Results In 31 cases, there were 29 cases of survival and 2 cases of necrosis. At 1-14 days after operation, the swelling of B and C group was significantly lighter than that in group A, and the duration of swelling was shorter. The survival cases were followed up for 3 months to 14 months, with an average of 9.5 months. The appearance of the flaps were not significantly swollen, soft texture; 19 cases had mild to moderate contracture, no severe contracture; 18 cases of skin color were close to the normal skin, 11 cases of skin color were slightly darker than the surrounding skin, with slight pigmentation; skin flap sensory recovery: 0 cases of grade 4, grade 3 in 5 cases, 18 cases of grade 2,grade 1 in 6 cases, 2 PD for 10 ～18 mm, average14 mm. Conclusion The free forearm no-inverted venous flap is a simple, convenient and safe method to repair hand wound. We should pay attention to establish an appropriate ratio of arteriovenous anastomosis according to the condition of the wound. When the flap is larger than 9 cm2, the ratio of arterial return veins to 1:2 or above can improve the long-term survival quality of the flap.
引文
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[2]朱家恺,卢传新,王成书,等.周围神经外科学[M].海口:三环出版社,1991.251-255.
[3]白杰,许玉本,周海振,等.桡动脉掌浅支腕横纹游离皮瓣修复治疗手部创伤的临床效果[J].局解手术学杂志,2017,26(6):435-438.
[4]刘建标.手部创伤患者应用桡动脉掌浅支腕横纹游离皮瓣修复的临床效果观察[J].创伤外科杂志,2015,17(3):240-242.
[5]宋达疆,李赞,周晓,等.游离带感觉超薄股前外侧穿支皮瓣修复甲瓣供区创面的疗效观察[J].中国修复重建外科杂志,2017,31(8):987-991.
[6]蔡正强.四肢皮肤复合组织缺损应用游离胸脐皮瓣和股前外侧皮瓣修复的效果观察[J].中国医学创新,2016,13(5):80-83.
[7]李瑞华,阔世廉,许效冲,等.动脉化静脉皮瓣两种灌流方式比较的实验研究及临床应用[J].中华手外科杂志,2006,22(4):242-244.
[8]李程科,肖军波,梁江声,等.一蒂多叶不反转动脉化静脉皮瓣一次性修复手部多创面损伤[J].中华显微外科杂志,2014,37(6):608-610.
[9]陈国恩.不同灌流方式对游离动脉化静脉皮瓣存活效果的影响[J].中国现代药物应用,2016,10(11):115-116.
[2]朱家恺,卢传新,王成书,等.周围神经外科学[M].海口:三环出版社,1991.251-255.
[3]白杰,许玉本,周海振,等.桡动脉掌浅支腕横纹游离皮瓣修复治疗手部创伤的临床效果[J].局解手术学杂志,2017,26(6):435-438.
[4]刘建标.手部创伤患者应用桡动脉掌浅支腕横纹游离皮瓣修复的临床效果观察[J].创伤外科杂志,2015,17(3):240-242.
[5]宋达疆,李赞,周晓,等.游离带感觉超薄股前外侧穿支皮瓣修复甲瓣供区创面的疗效观察[J].中国修复重建外科杂志,2017,31(8):987-991.
[6]蔡正强.四肢皮肤复合组织缺损应用游离胸脐皮瓣和股前外侧皮瓣修复的效果观察[J].中国医学创新,2016,13(5):80-83.
[7]李瑞华,阔世廉,许效冲,等.动脉化静脉皮瓣两种灌流方式比较的实验研究及临床应用[J].中华手外科杂志,2006,22(4):242-244.
[8]李程科,肖军波,梁江声,等.一蒂多叶不反转动脉化静脉皮瓣一次性修复手部多创面损伤[J].中华显微外科杂志,2014,37(6):608-610.
[9]陈国恩.不同灌流方式对游离动脉化静脉皮瓣存活效果的影响[J].中国现代药物应用,2016,10(11):115-116.