预制减压型静脉动脉化皮瓣的临床应用

李征; 张振伟; 余少校; 柯于海; 熊懿; 林慧鑫; 陈文锋

doi:10.13418/j.issn.1001-165x.2018.04.016

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (4) : 430-432. DOI: 10.13418/j.issn.1001-165x.2018.04.016

临床研究

预制减压型静脉动脉化皮瓣的临床应用

李征，　张振伟，　余少校，　柯于海，　熊懿，　林慧鑫，　陈文锋

作者信息 +

The clinical application of prefabricated-decompression arterialized vein flap

LI Zheng, ZHANG Zhen-wei, YU Shao-xiao, KE Yu-hai, XIONG Yi, LIN Hui-xin, CHEN Wen-feng

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文章历史 +

摘要

目的　探讨应用调节皮瓣载荷理论对静脉动脉化皮瓣进行预制减压处理的临床应用效果。方法　2016 年1月至2017年5月，对临床上24例手指皮肤软组织缺损患者应用预制减压型静脉动脉化皮瓣，皮瓣切取面积最大6.0 cm × 4.0 cm，最小2.0 cm×2.0 cm，术后应用激光闪斑多普勒血流成像仪在不同时间段测量皮瓣血流灌注量，观察皮瓣成活质量及修复效果。结果　术后24例静脉动脉化皮瓣全部成活，其中1例皮瓣远端出现水疱及皮下瘀血，其余23例皮瓣均无明显水疱形成，无明显肿胀，皮瓣血流灌注量观测发现术后72 h稳定并趋近于生理灌注水平。经过3~24个月随访，发现皮瓣外观满意，质地良好，成活质量好。结论　预制减压型静脉动脉化皮瓣在静脉回流不充分的情况下，可调节皮瓣的灌注量与回流量达到平衡，进而提高皮瓣成活质量，达到精细修复手部皮肤缺损创面的要求，值得临床推广。

Abstract

Objective　To investigate clinical effects of prefabricated-decompression arterialized vein flap. Methods　From January 2016 to May 2017, 24 cases of soft tissue defects of fingers and thumbs were repaired with the prefabricated-decompression arterialized vein flap. The flaps ranged from 2.0cm×2.0 cm to 6.0 cm × 4.0 cm. The perfusion volume of the flaps was measured by the laser flash spot doppler blood flow imaging instrument. Results 24 flaps survived completely, only 1 flap suffered partial margin blister and ecchymoma. No blister and swelling were found in the other 23 flaps. Patients were followed up for 3 to 24 months. The appearance of flaps was satisfactory and the texture was soft and good. Conclusion　There is a significant effect by using the prefabricated-decompression arterialized vein flaps, which has a reduced lead through a better balance of perfusion and drainage. With prefabricated-decompression adjustment, the survival rate and quality of the flaps can improved significantly.

导出引用

李征，　张振伟，　余少校，　柯于海，　熊懿，　林慧鑫，　陈文锋. 预制减压型静脉动脉化皮瓣的临床应用[J]. 中国临床解剖学杂志. 2018, 36(4): 430-432 https://doi.org/10.13418/j.issn.1001-165x.2018.04.016

LI Zheng, ZHANG Zhen-wei, YU Shao-xiao, KE Yu-hai, XIONG Yi, LIN Hui-xin, CHEN Wen-feng. The clinical application of prefabricated-decompression arterialized vein flap[J]. Chinese Journal of Clinical Anatomy. 2018, 36(4): 430-432 https://doi.org/10.13418/j.issn.1001-165x.2018.04.016

参考文献

[1] Nakayama Y, Soeda S, Kasai Y. Flaps nourished by arterial inflow through the venous system: an experimental investigation[J]. Plast Reconsr Surg, 1981, 67(3): 328-334.
[2] Jones BM , Sanders R, Greenhalgh RM. Interstitial fluid pressure as a circulatory monitior in skin flaps[J]. Br J Plas Surg, 1983, 36(3): 358-362.
[3] 熊懿，李征，周望高, 等. 调节动脉化静脉皮瓣前负荷的实验研究[J]. 中华手外科杂志，2014，30（6）: 461-464.
[4] 李征，钟科明，熊懿，等. 游离皮瓣前负荷调节的实验研究[J]. 中华手外科杂志，2016，32（1）：40-43.
[5] Tsoutsos D, Gravvanis A, Kakagia D, et al. Preservation of venous outflow improves transverse rectus abdominis musculocutaneous flap survival following vascular delay[J]. Acta Chir Plast, 2009, 51(1): 11-14.
[6] Chavoin JP , Rouge D, Vachaud M, et al. Island flaps with an exclusively venous pedicle. A report of eleven cases and a preliminary haemodynamic study[J]. Br J Plast Surg, 1987, 40(2),149-154.
[7] Unal C, Yasar EK, Sarisoy TH. The role of preoperative radiological assessment of vascular injury on surgical decision making in mutilating injuries of the upper extremity[J]. Ann Plast Surg, 2013, 70(3): 289-295.
[8] Beak SM , Weinberg H, Song Y, et al. Experimental studies in the survival of venous island flaps without arterial inflow[J]. Plast Reconstr Surg, 1985, 75(1): 88-95.
[9] 修志夫, 陈宗基. 静脉蒂营养的静脉皮瓣病理游离过程及临床应用可行性的研究[J]. 医学研究通讯, 2000, 3: 29.
[10] 赵永刚, 范金才. 静脉淤血组织的成活机制探讨[J]. 中国美容整形外科杂志, 2007, 18(6): 470-473.
[11] Brown JS, Devine JC, Magennis P, et al. Factors that influence the outcome of salvage in free tissue transfer[J]. Br J Oral Maxillofac Surg, 2003, 41(1): 16-20.
[12] 周望高，陈乐锋，余少校，等. 仅吻合指动脉终末支指尖再植的临床评价及流体力学分析[J]. 中华手外科杂志，2014，30（4）: 283-285.