带蒂逆行腓肠神经营养血管皮瓣静脉危象的术中挽救
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摘要
目的带蒂逆行腓肠神经营养血管皮瓣转移术若出现静脉危象,采取穿支动脉吻合手术加强动脉供血,观察其挽救效果。方法 2012年1月-2016年5月,足踝部及周围软组织缺损27例,行逆行腓肠神经营养血管皮瓣修复术,术中若发现皮瓣近端红润、远端暗紫,远近端肤色界限分明等静脉危象,则采取皮瓣内穿支动脉与足背动脉分支吻合术以挽救。结果 7例术中出现静脉危象,采取穿支动脉吻合手术挽救后,皮瓣远端颜色变红,2周后未见皮瓣远端坏死。随访18～24个月,皮瓣质地优良、耐磨性好,行走功能基本正常。结论带蒂逆行腓肠神经营养血管皮瓣转移术出现静脉危象时,采取穿支动脉吻合手术挽救,方法简单,效果可靠。
Objective To observe the rescue outcome in retrograde pedicled sural neurocutaneous vascular flap by supercharging the perforating arterial anastomosis for better blood supply when venous crisis occurred. Methods Twenty seven patients with ankle and foot soft tissue defects between Jan 2012 and May 2016 were reviewed, retrograde sural neurocutaneous vascular flaps were performed on all patients for reconstructions. During operations, anastomosis of perforating artery in flap to dorsal arterial branch was applied as the rescue if venous crisis was observed which were characterized by bright red at the flap proximal end coupled with dark purple color at the distal end or clear color differentiation between far and near sides. Results Seven patients had venous crisis during operations. After anastomosis of perforating artery was performed as the surgical rescue, the skin color turned to bright red at flap distal end with no necrosis two weeks after the operation. Examination at 18 ～24 months postoperative followup showed that skin texture of flaps was satisfactory with good abrasion resistance. Walking functions were assessed as basically normal on these patients. Conclusion In patients harvesting the retrograde sural neurocutaneous vascular flap with vein crisis, anastomosis of perforating artery in flap to branch of pedal dorsal artery can be performed. The procedure is simple and reliable.
Objective To observe the rescue outcome in retrograde pedicled sural neurocutaneous vascular flap by supercharging the perforating arterial anastomosis for better blood supply when venous crisis occurred. Methods Twenty seven patients with ankle and foot soft tissue defects between Jan 2012 and May 2016 were reviewed, retrograde sural neurocutaneous vascular flaps were performed on all patients for reconstructions. During operations, anastomosis of perforating artery in flap to dorsal arterial branch was applied as the rescue if venous crisis was observed which were characterized by bright red at the flap proximal end coupled with dark purple color at the distal end or clear color differentiation between far and near sides. Results Seven patients had venous crisis during operations. After anastomosis of perforating artery was performed as the surgical rescue, the skin color turned to bright red at flap distal end with no necrosis two weeks after the operation. Examination at 18 ～24 months postoperative followup showed that skin texture of flaps was satisfactory with good abrasion resistance. Walking functions were assessed as basically normal on these patients. Conclusion In patients harvesting the retrograde sural neurocutaneous vascular flap with vein crisis, anastomosis of perforating artery in flap to branch of pedal dorsal artery can be performed. The procedure is simple and reliable.
引文
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[2]Sugg KB,Schaub TA,Concannon MJ,et al.The reverse superficial sural artery flap revisited for complex lower extremity and foot reconstruction[J].Plast Reconstr Surg Glob Open,2015,3(9):e519.
[3]El-Diwany M,Karunanayake M,Al-Mutari S,et al.Superdrained distally based neurofasciocutaneous sural flap:a case series and review of literature[J].Eplasty,2015,12,15:e16.
[4]Shi-Min Chang,Xiao-Hua Li,Yu-Dong Gu.Distally based perforator sural flaps for foot and ankle reconstruc tion[J].World J Orthop,2015,6(3):322-330.
[5]钱永明,张平,朱春平,等.吻合穿支动脉挽救逆行转移腓肠神经营养皮瓣血循环障碍七例[J].中华显微外科杂志,2016,39(1):100.
[6]王培吉,周聚普,江波,等.改变动静脉压力差对逆行岛状皮瓣成活面积的影响[J].中华显微外科杂志,2015,38(2):144-148.
[7]Tanaka Y,Tajima S.The influence of arterial inflow and venous outflow on the survival of reversed-flow island flaps:experimental study[J].Plast Reconstr Surg,1997,99(7):2021-2029.
[8]陈文,李养群,唐勇,等.大鼠腹部增压皮瓣模型中动、静脉增压作用的研究[J].中华整形外科杂志,2013,29(1):40-44.
[9]顾玉东.皮瓣的静脉危象及其处理[J].中华手外科杂志,1996,12(3):131-133.