Objective To investigate the clinical effects of large flow-through venous flap for salvaging the limb on the verge of amputation complicated with arterial defect.Methods Between March 2012 and January 2015,large flow-through venous flap was used in 10 patients with upper limb on the verge of amputation to reconstruct artery defect and large-area skin and soft tissue defect,including 6 males and 4 females with a mean age of 27.9 years (range,18 to 41 years).Injury was caused by machine crush in 4 patients,twisting belt pulley in 4,and traffic accident in 2.The dimension of skin defect ranged from 6.5 cm× 10.0 cm to 10.5 cm × 18.0 cm (mean,9.0 cm × 12.0 cm).Vascular defect length ranged from 6.0 to 16.0 cm (mean,12.3 cm).Time from injury to operation was 1.5-5.5 h (mean,3.5 h).After operation,flap survival,appearance,texture and sensation were recorded.Upper limb function was evaluated using the standard set up by hand surgery branch of Chinese Medical Association.Results The flap varied in size from 8.0 cm×12.0 cm-12.0 cm ×20.0 cm (mean,10.0 cm × 13.5 cm).One patient was amputated due to severe postoperative infection,and 9 patients were successfully operated.The flap showed small-area necrosis on the distal end in 2 patients,which was cured after dressing change,while survived completely in 7 patients.The donor wounds healed in one stage.After 12-27 months of follow-up (mean,13.7 months),the thickness,texture and appearance of the flap were close to the surrounding normal tissues and the skin protective sensation was restored.The functional results were excellent in 6 patients,good in 2 and poor in 1,with the excellent and good rate of 89％.Conclusion Large flow-through venous flap can reconstruct upper-limb vascular defect while repairing large-area wound,and has advantages of easy operation,less damage to the donor site and good appearance.%目的 探讨应用大型血流桥接静脉皮瓣挽救伴动脉缺损的濒临截肢上肢的临床疗效. 方法 选择2012年3月-2015年1月10例伴动脉缺损及皮肤软组织大面积缺损的上肢濒临截肢伤患者,其中男6例,女4例;年龄18～41岁,平均27.9岁.致伤原因:机器挤压伤4例,皮带轮绞伤4例,交通伤2例.皮肤软组织缺损范围6.5 cm×10.0 cm～10.5 cm ×18.0cm,平均9.0 cm× 12.0 cm;血管缺损长度6.0～16.0 cm,平均12.3 cm.受伤至手术时间1.5～5.5 h,平均3.5h.采用大型血流桥接静脉皮瓣游离移植,重建缺损动脉并同时修复创面进行保肢治疗.术后观察患肢皮瓣成活情况及皮瓣外观、质地及感觉恢复情况.根据中华医学会手外科学会上肢部分功能评定试用标准评定患肢功能. 结果 本组切取皮瓣范围8.0 cm×12.0 cm ～ 12.0 cm×20.0 cm,平均10.0cm×13.5 cm.1例因术后创面严重感染而截肢;9例保肢成功,其中2例皮瓣远端小面积表皮坏死,换药后自行愈合,7例皮瓣完全成活,供区创面植皮均Ⅰ期愈合.术后随访12～27个月,平均13.7个月.皮瓣外观、质地和厚度接近周围正常组织,恢复保护性感觉.患肢功能评定:优6例,良2例,差1例,优良率为89％. 结论 大型血流桥接静脉皮瓣可重建上肢缺损血管并同时修复大面积创面,该方法具有手术简便、供区损伤小、术后美观的优点,值得临床应用.
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