拇手指再造的多组织移植术后血管危象探讨

发布时间：2018-04-03 03:37

本文选题：拇手指再造　切入点：游离组织移植　出处：《中国修复重建外科杂志》2017年03期

【摘要】：目的通过回顾多个游离组织再造拇手指并修复足部供区的患者资料,探讨术后血管危象发生的原因及有效处理方法,提高移植组织成活率。方法 2012年2月—2015年10月,收治59例拇手指缺损患者。男46例,女13例;年龄18~42岁,平均30.6岁。采用不同形式的与?甲瓣同一血管蒂的复合组织瓣移植再造拇手指并修复皮肤缺损,同时用穿支皮瓣修复供区,共涉及197个游离组织。术后17例21个游离组织(10.7%)(再造指或皮瓣)发生血管危象,其中动脉危象8例9个游离组织(4.6%),静脉危象10例12个游离组织(6.1%)。首先均行保守治疗;7例8个游离组织因保守治疗无效,行术中探查发现4例5个游离组织吻合口栓塞,1例1个游离组织血管蒂扭曲,1例1个游离组织血肿压迫,1例1个游离组织吻合口栓塞合并血肿压迫,予以清理血肿、切除栓塞血管、调节血管张力、重新吻合或血管移植处理。结果动脉危象患者中,5例5个游离组织经保守治疗后症状缓解,全部成活;3例4个游离组织行手术探查者,其中1个发生部分坏死。静脉危象患者中,6例8个游离组织经保守治疗后1个发生坏死,1个发生部分坏死;4例4个游离组织行手术探查,其中1个部分坏死。4个发生坏死部位,2个行再次皮瓣修复,2个行植皮修复,均成活。结论多个游离组织移植再造拇手指术后血管危象情况复杂,一旦发现危象应及时处理,可获得较高成活率。
[Abstract]:Objective to review the data of multiple free tissue reconstruction of thumb and finger and repair the donor area of foot, and to explore the causes and effective treatment of vascular crisis after operation, so as to improve the survival rate of transplanted tissue.Methods from February 2012 to October 2015, 59 patients with thumb and finger defects were treated.There were 46 males and 13 females with an average age of 30.6 years (1842 years).Adopt different forms and?The composite tissue flap with the same vascular pedicle was used to reconstruct thumb and finger and repair the skin defect, and the perforating branch flap was used to repair the donor area, involving 197 free tissues.Vascular crisis occurred in 17 cases (21 cases) with 10. 7 free tissue (reconstruction finger or flap), in which arterial crisis occurred in 8 cases (9 free tissues) and venous crisis in 10 cases (12 free tissues).First of all, 7 cases of 8 free tissues were treated with conservative therapy.Intraoperative exploration revealed that 4 cases (5 free tissues) were embolized with anastomotic stoma, 1 case (1 case) with 1 free tissue vascular pedicle, 1 case (1 case) with compression of free tissue hematoma, 1 case (1 case) with embolization of anastomotic site with hematoma compression, and 1 case (1 case) with hematoma compression.Removal and embolization of blood vessels, regulation of vascular tension, re-anastomosis or vascular graft management.Results the symptoms of 5 free tissues in 5 patients with arterial crisis were relieved after conservative treatment, 3 patients survived and 4 free tissues were operated on, one of them had partial necrosis.Among the patients with venous crisis, 1 necrotic occurred in 6 cases and 4 free tissues in 4 cases after conservative treatment.Among them, 1 was partially necrotic, 4 were necrotic, 2 were repaired by reflap, 2 were repaired by skin graft, all survived.Conclusion the situation of vascular crisis after reconstructing thumb and finger with multiple free tissue transplantation is complicated. Once the crisis is found, it should be dealt with in time to obtain a higher survival rate.
【作者单位】：宁波市第六医院手外科;
【基金】：宁波市江东区科技局基金项目(2015A610312)~~
【分类号】：R658.1

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