头静脉周围血管营养皮瓣修复皮肤缺损45例

摘要

Objective To discuss the clinical effect of treating skin defect with vasculotrophic flaps around cephalic veins. Methods We used 45 vasculotrophic flaps around cephalic veins to treat 45 patients with skin defect, from February 2008 to March 2012. The follow-up time was 6 months to 1 year, 10 months on average. Based on the surgical methods, the surgical flaps were divided into two classes, one was antegrade flap, with the flap at the distal end of the pedicle. And the other was retrograde flap, with the flap at the proximal of the pedicle. Type I of the second class:reflux vein could be found inside the wound surface, and the cephalic vein inside the flap was anastomosed with the reflux vein inside the wound surface. Type II of the second class: reflux vein could not be found inside the wound surface, and the cephalic vein inside the flap tissues was ligated. Flaps were cut from deep fascial layer, the pedicle width has cephalic vein as the center, not less than 3.0 cm, and the flap length-to-width ratio should not be greater than 5:1. The pedicle of free flap has a strip of skin for reducing tension during suturing. The superficial cutaneous nerves should be kept when cutting the skin flaps. Results Through the method of vasculotrophic flaps around cephalic veins, 45 flaps all survived. As the cutaneous nerve was kept when cutting the flaps, the sensory function of the body was good. Conclusion The cephalic veins exist inside the fascia tissues, and have more concentrated arteries around to supply blood, which provide nutrition to cephalic veins and peripheral tissues. Various vasculotrophic flaps around cephalic veins could be designed by utilizing these tissues for blood supply. As the skin flaps only contain cephalic veins and don't injure nerves and arteries, the damage to the limb is small and higher survival rate, so it has broad application prospects.%目的：探讨头静脉周围血管营养皮瓣修复皮肤缺损的临床疗效。方法对2008年2月-2012年3月收治的45例皮肤缺损患者采用头静脉周围血管营养皮瓣的方法治疗，共切取45个皮瓣。术后随访6~12个月，平均10个月。根据皮瓣的手术方法分两类，一类：顺行皮瓣，皮瓣位于蒂部的远端。二类：逆行皮瓣，皮瓣位于蒂部的近端。二类一型：创面内能找到可吻合的回流静脉，将皮瓣内的头静脉与创面内的回流静脉吻合。二类二型：创面内找不到可吻合的静脉，皮瓣组织内的头静脉结扎。皮瓣切取位于筋膜层深层，蒂宽以头静脉为中心，不大于3.0 cm。皮瓣长宽比例不能大于5：1。游离皮瓣蒂部根据情况带一条形皮肤，缝合时减少张力。在切取皮瓣时遇到表浅皮神经要注意保留。结果通过头静脉周围血管营养皮瓣的方法，45例皮瓣均成活。由于切取皮瓣时保留了皮神经，皮瓣修复后肢体的感觉功能良好。结论头静脉存在于筋膜组织中，其周围伴行着比较集中的小动脉营养供血，营养着头静脉及其周围组织，利用这套组织供血，可以设计各种头静脉周围血管营养皮瓣。由于皮瓣只含头静脉不损伤神经及动脉，因此对肢体损伤小，成活率高，有广阔的应用前景。