游离皮瓣移植经验及三种不同血管吻合方式对皮瓣成活影响的比较分析

【作者】 田佳； 范金财； 焦虎； 甘承； 刘立强； 陈光宇；

【机构】 中国医学科学院整形外科医院；

【摘要】 目的:总结近7年来我科所行的肩胛(肩胛旁)游离皮瓣移植手术,对所应用的不同血管吻合方式进行评价。方法:对48例患者瘢痕或组织缺损利用肩胛(肩胛旁)游离皮瓣进行修复,术中采用三种不同的血管吻合方式:其中20例采用显微镜下缝线法吻合,18例采用手术放大镜下缝线法吻合,10例采用国产73-Ⅱ型血管吻合器吻合。对其中35例成人肩胛(肩胛旁)皮瓣游离移植病例按吻合方式的不同分为显微镜血管吻合组、放大镜血管吻合组、血管吻合器组,比较皮瓣缺血时间、血管吻合总时间、并发症率等在3组中的差异。结果:48例游离皮瓣移植中,因已存在受区血管损伤致术中更改手术方式者1例,其余47例完成游离移植的皮瓣中,术后出现血运相关并发症8例,经保守治疗及血管探查等积极处理后,完全坏死2例,总皮瓣移植成功率95.7%。在显微镜血管吻合组、放大镜血管吻合组、血管吻合器组中皮瓣缺血时间分别为125.5433.07min、121.4624.36min、22.6611.01min,血管吻合时间分别为82.5427.11min、73.5318.83min、17.669.05min,经两两统计学比较,吻合器组与两个缝线组之间p值均小于0.01,有统计学意义;而两缝线组之间均大于0.05,无统计学差异。血运相关并发症的发生率分别是27.27%,21.43%,0%。三组在统计学比较中无明显差异。结论:应用73-Ⅱ型血管吻合器吻,相比传统缝线法吻合可明显减少皮瓣缺血时间,缩短血管吻合时间。通过完善的术前设计、精细的手术操作、妥善的术后处理可以提高皮瓣的成活率,提高手术治疗的成活率。更多还原

【Abstract】 Objective:Based on the review of our experience in the free scapular(parascapular) flaps transplanted operations in our unit in the past seven years,to evaluate the values in the 3 methods of vascular anastomoses. Method:The subjects were 48 consecutive patients who had undergone the scapular(parascapular) flaps with different microsurgical vascular anastomoses techniques.During the operations,three methods of the anastomoses were applied:①suture method under microscope for 20 flaps,②suture method with loupe for 18 flaps,③Chinese-made 73-Ⅱvascular anastomoses device for 10 flaps.The 35 adult patients in the group were drawn out to compare among the 3 methods of the vascular anastomoses as following:the microscopic group,the loupe group and the anastomoses device group.The comparison included the ischemia time of the flaps,the total anastomosing time and the complication incidence within the three groups. Results:Except for 1 flap which were unavailable for vascular anastomoses due to the recipient site vessels damage, there were 10 complications.After appropriate management,there were 2 failures in the remaining 47 flaps.The successful rate of anastomoses was 95.7%.The ischemia time of the flaps in the three groups were:125.5433.07mm in the microscopic group,121.4624.36min in the loupe group,22.6611.01mm in the anastomoses device group.The total anastomoses time are:82.5427.nmin in the microscopic group,73.5318.83min in the loupe group,17.669.05min in the anastomoses device group.After statistical analysis between each two groups,p<0.01 between the microscope group and the other two groups,with significant statistical difference;p>0.05 between the two suture groups.The blood supply associate complication incidences were 27.27%in the microscopic group,21.43%in the loupes group,0%in the anastomoses group.However there was no significant difference had been found among the three groups. Conclusion:The usage of 73-Ⅱvascular anastomoses device can significant shorten ischemia time of the flaps and the total anastomoses time.The survival rate of the free flaps could be increased by means of thorough preoperational design,dedicate procedure and appropriate post-operative managements更多还原