35例股前外侧游离皮瓣血管危象临床分析

上海口腔医学 ›› 2016, Vol. 25 ›› Issue (1): 112-116.

35例股前外侧游离皮瓣血管危象临床分析

任振虎¹, ²，吴汉江²*，谭宏宇²，王铠²，龚朝建²，张胜²*

1.上海交通大学医学院附属第九人民医院?口腔医学院口腔颌面-头颈肿瘤科，上海 200011；
2.中南大学湘雅二医院口腔颌面外科，湖南长沙 410011

收稿日期:2015-01-14 修回日期:2015-04-28 出版日期:2016-02-25 发布日期:2016-03-09
通讯作者: 张胜，E-mail:ddszhangsh@gmail.com;吴汉江，E-mail:wuhanjiang0198@sina.com。*并列通信作者 E-mail:zhenhuren@126.com
作者简介:任振虎(1986-)，男，博士，住院医师

Clinical analysis of 35 flap crisis in anterolateral thigh free flaps

REN Zhen-hu¹,², WU Han-jiang², TAN Hong-Yu², WANG Kai², GONG Zhao-jian², ZHANG Sheng².

1.Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
2.Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University. Changsha 410011, Hunan Province, China

Received:2015-01-14 Revised:2015-04-28 Online:2016-02-25 Published:2016-03-09

摘要/Abstract

摘要： 目的： 总结分析股前外侧游离皮瓣术后血管危象发生的可能原因，探讨影响股前外侧游离皮瓣移植成功率的因素，为进一步提高皮瓣移植成功率提供参考。方法： 回顾2005年9月—2012年12月中南大学湘雅二医院口腔颌面外科行股前外侧游离皮瓣移植修复的患者，记录皮瓣危象发生的时间、危象类型及抢救结果。计算皮瓣移植成功率、皮瓣危象发生率、危象抢救成功率等。应用SPSS 16.0软件包对数据进行χ2检验或Fisher精确检验。结果： 812块股前外侧游离皮瓣移植成功率为97.8% (794/812)。发生血管危象者35块，抢救成功17块，坏死18块。35块发生血管危象的皮瓣中，静脉危象31块 (88.6%) 、动脉危象4块(11.4%)。术后16 h内皮瓣抢救成功率显著高于术后16h以后的抢救成功率(70.6%∶27.8%, P=0.011)，静脉危象的抢救成功率高于动脉危象的抢救成功率(51.6%∶25.0%,P=0.316)，但差异无显著性。穿支血管受损是导致股前外侧皮瓣危险的重要原因之一。结论： 早期发现并及时手术探查是提高皮瓣危象抢救成功率最有效的方法。针刺出血试验是目前判断皮瓣危象发生与否及危象类型最准确的临床观察方法，也是目前判断皮瓣危象发生与否及危象类型的金标准。

关键词: 游离皮瓣, 股前外侧皮瓣, 皮瓣危象, 静脉危象, 动脉危象

Abstract: PURPOSE： The aim of this study was to analyze the causes of anterolateral thigh (ALT) free flap compromise and improve the success rate of ALT. METHODS： Patients were recruited from September 2005 to December 2012 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients underwent reconstructive surgery using ALT free flaps. Outcome measures included ethnicity, defect type, incidence and timing of flap compromise, type of flap compromise (i.e. arterial or venous), causes of vascular occlusion and salvage rate. The data was analyzed using SPSS 16.0 software package. RESULTS: There were a total of 812 ALT free flaps transplanted during 7 years. Among the 812 transferred flaps, 794 survived and 18 showed necrosis, the overall survival rate was 97.8%. 35 flap compromises due to vascular obstruction were identified and 18 flaps were salvaged completely after exploration. Venous occlusions occurred in 31 flaps (88.6%) and arterial occlusion in 4 flaps (11.4%). The successful salvage rate within 16 h was significantly higher than those over 16 h (70.6%: 27.8%, P=0.011). The successful salvage rate of venous occlusions was higher than that of arterial occlusion, but there was no significant difference. CONCLUSIONS: Early detection, re-exploration, and effective handling of the flap crisis increase the rate of flap salvage tremendously. Prick test is the gold standard for early detection of flap compromise.

Key words: Free flap, Anterolateral thigh free flap, Flap compromise, Venous occlusions, Arterial occlusions

中图分类号:

R782.2

任振虎, ，吴汉江*，谭宏宇，王铠，龚朝建，张胜*. 35例股前外侧游离皮瓣血管危象临床分析[J]. 上海口腔医学, 2016, 25(1): 112-116.

REN Zhen-hu,², WU Han-jiang², TAN Hong-Yu², WANG Kai², GONG Zhao-jian², ZHANG Sheng².. Clinical analysis of 35 flap crisis in anterolateral thigh free flaps[J]. Shanghai Journal of Stomatology, 2016, 25(1): 112-116.

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