Objective To evaluate the effect of low-molecular-weight heparin in the distally-based fascial flap to reduce venous congestion and increase flap survival quality. Methods From March 2007 to June 2009, 13 patients were treated with distally-based dorsoradial nerve fasciocutaneous flap for coverage of wounds of the thumb. The flap area was about 1.7 cm× 2.0 cm to 3.0 cm× 4.5 cm. Vascular pedicle length was about 1.5 cm to 3.0 cm. According to the order of the surgery, the patients were divided into two groups. Conventional treatment was given to the patients in group A, while in group B low molecular weight heparin was subcutaneous injected 5 000 IU once a day for 5 days. Blood circulation of the flaps was observed postoperatively. Results Blood circulation of the flaps was good in the early postoperative stage. After 1 to 2 days, blood oozing from flap edges stopped in group A. Three flaps began to appear obviously swelling. The color of the distal flaps turned dark purple. Removal some of the stitches, full-thickness incision on the flap and repeated draining dark red congested venous blood gradually turned the color of the flaps pink. All flaps survived eventually. In group B the bleeding time of the flaps were significantly longer than that in group A, and no flap showed obvious venous congestion or swelling. All the flaps survived with good quality. Three week to 2 months follow-up showed normal skin color, soft flap texture and good thumb movement. Conclusion The application of low-molecular-weight heparin can improve the microcirculation within the flap and increase the quality of flap survival after subcutaneous injection through increasing bleeding of flaps to release venous congestion of the flaps.%目的 探讨应用低分子肝素钠以减少皮瓣内静脉血淤滞,提高皮瓣存活质量的效果.方法 自2007年3月至2009年6月,应用拇指桡背侧远端蒂皮神经筋膜皮瓣修复拇指创面13例,皮瓣面积1.7 cm×2.0 cm～3.0 cm×4.5 cm,蒂长1.5～3.0cm.按手术先后顺序分为2组,术后A组给予常规处理,B组加用皮下注射低分子肝素钠5000 U,每日1次,共5 d.术后观察皮瓣血液循环情况.结果 两组皮瓣早期血液循环良好.A组术后1～2 d创面渗血停止后,3例出现明显的肿胀,皮瓣远端部分颜色暗紫,经拆除部分缝线,皮瓣全层切开,挤压擦拭至有暗红色静脉淤血渗出后,皮瓣颜色逐渐转为红润,经多次反复处理后皮瓣存活;其余皮瓣存活良好.B组皮瓣的渗血时间及渗血量明显增加,未出现静脉危象,所有皮瓣均存活且质量高.术后随访3周至2个月,皮瓣颜色和周围皮肤基本一致,质地较软,拇指活动功能满意.结论 皮下注射低分子肝素钠能延长远端蒂皮瓣术后渗血时间,减轻皮瓣静脉回流的负荷,提高皮瓣存活质量.
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