逆行指动脉穿支蒂皮瓣切取后动脉供血障碍分析与补救方法

摘要

Objective To analyze the causes and remedies of the arterial crisis occured in retrograde digital arterial perforator flaps. Methods From December 2010 to September 2016, 17 cases of flap that had arterial blood crisis, remedied by Superficial vein and small artery anastomosis. Superficial vein existed in proximal or distal flap was anastomosed with the digital inherent artery or small artery in the wound. Then, arteriovenous bypass was established to improve the skin flap blood supply. Results 9 in 17 cases of arterial blood crisis got a ruddy complexion immediately, 6 cases were dark red skin colour and blisters on the second day, while turned rosy after 5-7 days, 2 cases lilac on the second day, partial flap necrosis appeared 1 week later and wound heaed after dressing change. Conclusion Taking the arteriovenous anastomosis immediately, when the arterial blood crisis occured in retrograde digital artery perforator flaps, can increase the flap blood supply, reduce the failure of operation.%目的 分析逆行指动脉穿支蒂皮瓣切取后即刻动脉供血障碍的原因及补救方法 .方法2010年12月-2016年9月,17例皮瓣切取后即发现动脉供血障碍,将进入皮瓣蒂部的浅静脉与指动脉吻合或将伤指创面内小动脉与皮瓣远侧缘浅静脉吻合,达到动-静脉转流的目的来改善皮瓣血运.结果 17例皮瓣中,9例术后皮瓣肤色红润Ⅰ期成活;6例术后第2天皮瓣暗红,有水疱形成,5～7 d后皮瓣转红润;2例术后第2天皮瓣淡紫,1周后皮瓣部分坏死,局部换药后创面愈合.结论 逆行指动脉穿支蒂皮瓣在切取后发现动脉供血障碍,积极进行动-静脉小血管吻合,增加组织瓣供血,能减少手术的失败.