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1.
目的:探讨拇、手指再造术后发生血管危象的原因,治疗方法及预防.方法:对10例拇、手指再造术后发生血管危象的患者进行回顾性分析,讨论血管危象发生的可能原因及处理,并对此做好预防措施.手术探查取出血管栓塞并重新吻合6例,经镇痛止痛解挛等治疗后纠正2例,1例通过换药,拆除部分缝线,1例通过指端切口放血并用肝素棉球湿敷等处理解决回流障碍.结果:10例经相关处理后血管危象均顺利解除,指体全部成活,成活率100%.经6月-5牟随访,平均24个月,再造指体功能恢复良好,感觉恢复满意,2-PD 5-9mm.结论:拇、手指再造术后血管危象的预防和及时正确处理是提高拇、手指再造成活率的重要保证.  相似文献   

2.
目的通过回顾多个游离组织再造拇手指并修复足部供区的患者资料,探讨术后血管危象发生的原因及有效处理方法,提高移植组织成活率。方法 2012年2月—2015年10月,收治59例拇手指缺损患者。男46例,女13例;年龄18~42岁,平均30.6岁。采用不同形式的与?甲瓣同一血管蒂的复合组织瓣移植再造拇手指并修复皮肤缺损,同时用穿支皮瓣修复供区,共涉及197个游离组织。术后17例21个游离组织(10.7%)(再造指或皮瓣)发生血管危象,其中动脉危象8例9个游离组织(4.6%),静脉危象10例12个游离组织(6.1%)。首先均行保守治疗;7例8个游离组织因保守治疗无效,行术中探查发现4例5个游离组织吻合口栓塞,1例1个游离组织血管蒂扭曲,1例1个游离组织血肿压迫,1例1个游离组织吻合口栓塞合并血肿压迫,予以清理血肿、切除栓塞血管、调节血管张力、重新吻合或血管移植处理。结果动脉危象患者中,5例5个游离组织经保守治疗后症状缓解,全部成活;3例4个游离组织行手术探查者,其中1个发生部分坏死。静脉危象患者中,6例8个游离组织经保守治疗后1个发生坏死,1个发生部分坏死;4例4个游离组织行手术探查,其中1个部分坏死。4个发生坏死部位,2个行再次皮瓣修复,2个行植皮修复,均成活。结论多个游离组织移植再造拇手指术后血管危象情况复杂,一旦发现危象应及时处理,可获得较高成活率。  相似文献   

3.
精神因素对拇手指再造术的影响   总被引:2,自引:1,他引:1  
目的探讨精神因素特别是焦虑与拇手指再造发生血管危象之间的相关性。方法对126例拇手指再造的病例进行焦虑状态评分,对评分进行分组,分别记录各组发生血管危象的频率、原因,并对结果进行统计学处理分析。结果发生血管危象的患者集中在汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)术前评分高于5分组;术前HAMA评分大于13分的病例发生顽固性血管痉挛的几率要大于5分以内者;术后治疗期间随着焦虑程度的增加发生顽固性血管痉挛的比例也在增加。结论焦虑程度的高低影响拇手指再造术后发生血管危象的频率,术前明显焦虑的患者更容易发生血管危象以及顽固性血管痉挛。HAMA评分大于13分的患者群体应该适当予以预防性的治疗。  相似文献   

4.
目的 报道手指中、末节缺损的显微外科修复方法。方法 本组采用吻合趾-指动、静脉和缝合神经的方法再造手指43例56指。结果 本组43例56指全部成活,其中有8例术后发生动脉危象,4例发生静脉危象,经积极处理或手术探查均成活。31例随访8个月~5年,患对再造指外形及功能满意。结论 拇、手指Ⅱ、Ⅲ度缺损时采用本术式具有不牺牲主要血管,创伤小、疗程短等优点,但需要术具有熟练的显微外科技术。  相似文献   

5.
足趾移植手指再造术血管危象的防治   总被引:1,自引:1,他引:0  
目的 探讨术前评估、术后处理在足趾移植手指再造术血管危象防治中的作用.方法 回顾1995-2007年间,我院收治的203例236指再造手术的患者,提出了术前、术中、术后各个环节防治血管危象的必要性,分析血管危象发生的时间、性质以及不同的处理和转归,比较2004年后针对性术前处理(多普勒超声检测及低分子肝素钠抗凝治疗)对减少血管危象发生的影响.结果 足趾移植再造术后41指发生血管危象,其中19指经保守治疗后,危象缓解,再造指全部存活;手术探查22指,成活21指,失败1指.总成活率达99.6%.2004年后收治的123指再造术,经针对性术前处理后,术后血管危象发生率为12.2%,较之2004年以前的23.0%有明显的降低.结论 提高足趾移植拇、手指再造的成活率,关键在于如何减少血管危象的发生.严谨的手术设计,把握术前、术中、术后三个环节的处理是降低血管危象发生的重要因素,积极手术探查则可以有效地提高成活率.  相似文献   

6.
目的探讨足趾组织游离移植拇手指再造手术的临床疗效。方法自2000年9月-2007年4月,针对各种类型的拇手指缺损或软组织缺损,采用不同形式的足趾组织游离移植进行拇手指再造手术共42例46指。结果再造手指坏死1例,其余41例45指全部成活。随访时间3个月~2年,按中华医学会手外科分会上肢部分功能评定试用标准进行评定:优15指,良20指,可8指,差2指。结论适宜的手术时机、娴熟的显微外科技术、血管变异与危象的正确处理和积极的康复训练,是足趾组织游离移植拇手指再造手术成功的关键。  相似文献   

7.
足趾移植拇手指再造的目的、手术方案与技巧商榷   总被引:20,自引:3,他引:17  
自1979年以来,我院对1255例不同程度拇、手指缺损者,选用不同形式足趾组织移植,施行拇、手指再造与修复达1569指,成功1545指,成功率为98.5%。新近对拇、手指部分缺损者,选用足趾相应组织移植进行修饰性修复与重建,获得了较满意的外形与功能,达到缺什么再造修复什么的临床效果,使拇、手指再造与修复获得了自由。在这26年手指再造的经历中,既有成功的经验,也有失败的教训,并摸索了一些新方法,积累了一些经验,愿在此与同道共商。  相似文献   

8.
足趾移植再造拇手指顽固性动脉痉挛的处理体会   总被引:2,自引:0,他引:2  
目的 介绍足趾移植再造拇、手指术中和术后发生顽固性动脉痉挛的处理方法。方法 对19例拇手指缺损的患者,应用游离第二足趾移植再造拇手指术,其中10例在足趾游离后血管断蒂前发生动脉顽固性痉挛,术中仍按常规处理方法进行血管断蒂,拇、手指再造术。9例发生在第二足趾移植再造拇、手指血管吻合通血后至术后83h出现动脉顽固性痉挛而行手术探查,术中将痉挛段动脉切除,取前臂浅静脉作移植。结果 术后按显微外科常规方法处理,19例再造拇、手指全部获得成活。结论 对拇、手指再造术中和术后出现的顽固性动脉痉挛,采用即时性断蒂或静脉移植桥接动脉的方法是可行、有效的。  相似文献   

9.
我院自1979年10月以来应用吻合血管的足趾组织移植再造拇、手指148例173指,成功144例169指,失败4例4指,成功率为97.7%。 男110例,女38例。16~40岁占125例。单纯拇指缺损85例,单纯手指缺损21例,拇指伴手指同时缺损42例。再造拇指116例118指,再造手指21例31指,再造拇、手指11例24指。  相似文献   

10.
目的分析利用拇趾趾尖移植再造拇、手指指尖的临床效果。方法2009年5月-2012年7月对18例18指指尖缺损患者,采用拇趾趾尖组织游离移植进行修复再造,常规吻合腓侧趾底动脉、趾底神经、趾背静脉。结果再造18例18指全部成活。1例术后早期发生血管危象,经手术探查后成活。术后全部病例均得到随访,随访时间为6个月-2年,再造手指外形接近正常手指,功能恢复良好。供区拇趾外形、功能无明显影响。结论拇趾趾尖移植再造拇、手指指尖,外形、功能好,供区损伤小,是指尖缺损的理想修复方法。  相似文献   

11.
Twenty-three toe-to-hand transfers performed in 21 children were monitored after surgery using differential pulse oximetry for 4 to 12 days. Pulse rate recorded by the pulse oximetry monitored the patency of the arterial anastomosis, whereas oxygen saturation (SaO(2)) corresponded to the patency of the venous anastomosis; these were both compared with the systemic pulse rate and oxygen saturation recorded by a second control pulse oximeter probe attached to a contralateral finger or toe. All 23 toe transfers were ultimately successful, but 2 required re-exploration for anastomotic problems detected by the pulse oximeter. Based on this experience, the following criteria have been developed for the nursing and junior medical staff: if the arterial pulse of the toe transfer is lost completely or if the pulse rate differs significantly from the systemic pulse rate, measured by the second control pulse oximeter, thrombosis of the arterial anastomosis should be suspected. If the oxygen saturation of the toe transfer decreases below the oxygen saturation measured by the control pulse oximeter and this differential is sustained over a period of time, thrombosis of the venous anastomosis should be suspected. Differential pulse oximetry appears to be superior to temperature monitoring and percutaneous and laser Doppler monitoring and provides the most simple and continuous technique of noninvasive postoperative monitoring of toe-to-hand transfers in children requiring reconstruction of traumatic or congenital deformities.  相似文献   

12.
Reconstruction of the lower extremity using microvascular free tissue transfer has been adopted as a routine procedure since the 1980s. Success rates in overall free tissue transfer are now as high as 98%. In the lower limb, however, the failure rate has been reported to be as high as 15 to 20%. A review of 50 consecutive microvascular free flaps to the lower extremity was carried out in the Ulster Hospital Belfast. The indication for surgery, the flap type, the recipient vessel, re-exploration rate, complication rate, success rate and the changing pattern in management during the first six years of a single consultant's practice was assessed. Six patients (12%) were re-explored for anastomotic complications or haematoma. Thrombosis of the arterial anastomosis was noted in one case, venous thrombosis in two and haematoma under the flap in the remaining three cases. Salvage was successful in four cases, thus producing an overall success rate of 96%.  相似文献   

13.
Introduction: Despite high success rates with free‐tissue transfer, flap loss continues to be a devastating event. Flap salvage is often successful if vascular complications are recognized and treated early. However, delayed presentation of flap compromise is an ominous predictor of flap loss. Late free‐flap salvage has been described with poor long‐term results. Catheter‐directed thrombolysis (CDT) has only been described in context with free‐tissue transfer in a case of distal bypass salvage. Objectives: The authors examined the efficacy of highly selective CDT in late salvage of free‐flaps with vascular compromise. Methods: Two patients underwent highly selective CDT after delayed presentation (>5 days) of flap compromise. Patient 1 is a 59‐year‐old woman who underwent delayed breast reconstruction with a free TRAM flap and presented with arterial thrombosis 12 days postoperatively. Patient 2 is a 53‐year‐old man who underwent fibular osteocutaneous free‐flap reconstruction of a floor of mouth defect who developed venous thrombosis 6 days postoperatively. Patient 2 underwent two attempted operative anastamotic revisions with thrombectomies and local thrombolysis prior to CDT. Results: The average time of presentation was 9 days, with the average time to CDT being 9.5 days. Patient 1 had an arterial thrombosis, whereas Patient 2 had a venous thrombosis. Both patients underwent successful thrombolysis after super‐selective angiograms. Continuous infusions of thrombolytic agents were used in both patients for ~24 h. Average length of stay postCDT was 7 days with no perioperative complications. Long‐term follow‐up demonstrated complete flap salvage with no soft tissue loss. Conclusion: Despite extremely delayed presentation, aggressive CDT was successful in both breast, and head and neck reconstructions with excellent long‐term flap results. CDT appears to be a useful modality in managing difficult cases of free‐flap salvage. © 2008 Wiley‐Liss, Inc. Microsurgery, 2008.  相似文献   

14.
吻合血管术后55例血管危象探查体会   总被引:1,自引:0,他引:1  
目的 对吻合血管术后55例(63次)血管危象进行临床分析.方法 对2004年4月至2007年12月在我院手外科有完整资料的55例(63次)发生血管危象的病例资料进行回顾性分析,其中断指再植29例、足趾移植手指再造17例、游离皮瓣8例、手指不全离断1例.所有病例均经保守治疗1h后血管危象无缓解而进行手术探查,根据术中所见血管情况进行相应处理,其中26例30次动脉栓塞、17例20次动脉痉挛、10例11次静脉栓塞、2例2次血管受压;其中包括动脉张力过低1例、静脉张力过高1例、动脉分支未结扎1例.根据术中所见,20例23次行前臂浅静脉血管移植,33例38次行栓塞段血管切除重新吻合,1例修剪压迫组织,1例清除局部血肿.结果 本组55例,存活51例,成活率92.73%.其中坏死的有断指再植2例,足趾移植手指再造1例,游离皮瓣1例.结论 血管吻合术后一旦发生血管危象,经保守治疗无效后,早期、积极地手术探查是挽救的关键措施.  相似文献   

15.
We report on 32 patients with vascular injury of a limb undergoing a total of 41 revascularization procedures with interposition vein grafts. A combined arterial and venous injury was present in nine cases, an isolated venous injury in four, and an isolated arterial injury in 19 cases. Eighteen per cent of patients with arterial injuries had normal distal pulses on initial examination. Preoperative arteriography was performed in 12 cases, and intraoperative arteriography in four. All venous injuries were diagnosed at operation. In most cases, the contralateral greater saphenous vein was used for grafting. Four patients had postoperative thrombosis after arterial reconstruction resulting in below knee amputation in two cases. Two patients suffered from postoperative swelling caused by venous insufficiency, one after ligation of an injured axillary vein, and the other one following venous thrombosis of a superficial femoral vein repair. It is concluded that revascularization of arterial and venous injuries of the extremities with interposition vein grafts is successful in most cases resulting in low amputation rates, and should be attempted in all major vascular injuries in viable limbs.  相似文献   

16.
BACKGROUND: Pancreas venous graft thrombosis after transplantation is the main non-immunological cause of graft failure and usually results in pancreatectomy. Duplex Doppler ultrasonography is the primary imaging technique for monitoring vascular patency after pancreas transplantation. This study reports the results of rescue treatments for pancreas graft thrombosis after simultaneous pancreas--kidney transplantation. METHODS: One hundred and ninety-six patients with insulin-dependent diabetes mellitus received a simultaneous pancreas--kidney transplantation. Venous graft thrombosis was diagnosed in 25 of these patients based on Doppler ultrasonographic findings. RESULTS: Total venous graft thrombosis was diagnosed in 20 symptomatic patients, of whom 14 required graft pancreatectomy. Surgical thrombectomy was attempted in six patients with preserved arterial supply and was successful in four. Partial venous graft thrombosis was diagnosed in five asymptomatic patients; one also had partial splenic artery thrombosis. Rescue graft procedures included systemic anticoagulation (one patient), arterial thrombolysis (one) and venous thrombolysis and/or mechanical venous thrombectomy (four episodes in three patients). Graft rescue was achieved in three patients treated by venous thrombolysis/thrombectomy. CONCLUSION: Doppler ultrasonography allows the appropriate selection of rescue treatment based on the findings of total or partial thrombosis.  相似文献   

17.
One hundred and eleven cases of free tissue transfer were reviewed to assess the indications for, and results of, such procedures. More than 90% of cases were seen after treatment of tumour or trauma, with the most utilized flaps being the radial forearm, jejunum and latissimus dorsi. Fifteen per cent of cases required re-exploration of the anastomosis, of which more than 75% were salvaged. Haematoma formation and venous thrombosis were the commonest problems and were more successfully treated than arterial occlusion. The overall success rate was 92%. Free microvascular tissue transfer is a useful and reliable technique, especially in the management of head and neck tumours and limb trauma. The most important factors relating to flap survival are the experience of the surgical team and the integrity of the anastomosis.  相似文献   

18.
OBJECTIVE: The association between cancer and venous thrombosis is well established, however, that between malignancy and arterial thrombosis is less well described. Isolated cases have been reported and chemotherapy has been implicated as a cause though its significance compared with the malignant disease process itself is not known. This study examines the outcome of patients with malignant disease who present with arterial thrombosis. METHOD: Details of patients with malignant disease who presented with arterial thrombosis were analysed. RESULTS: Twenty patients presented with malignancy and arterial thrombosis, 16 presented in the last four years. The most common malignancy was metastatic breast cancer. Thrombosis involved the leg in 19 cases and the arm in one. Four patients also had venous thromboembolic events and one had a carotid artery thrombosis. Eight patients underwent operative treatment for their thrombosis. Five out of six thromboembolectomies and two out of three bypass procedures failed. Twelve had conservative or palliative treatment. Outcome was generally poor, two patients had major amputations and seventeen died at median follow-up of eight weeks. Survival rate from the time of presentation of arterial thrombosis was 50% at three months and 17% at one year. CONCLUSION: Patients with critical limb ischaemia due to atherosclerotic disease have an expected survival of approximately 80% at one year. The outcome of patients with arterial thrombosis associated with malignant disease is far worse. Arterial thrombosis is an agonal event in many of these patients. Conservative or palliative treatment may be the most appropriate management.  相似文献   

19.
R D Goldner 《Hand Clinics》1985,1(2):205-215
Postoperative vascular compromise can result from a problem at the anastomotic site, including vessel damage, improperly placed sutures, trauma to the vessel, or atherosclerosis. Systemic factors include decreased blood flow, vascular spasm, and atherosclerosis. External compression such as hematoma, tight skin closure, or a large drain pressing on a vessel can compromise flow. In patients who are to undergo elective microsurgery, angiography at the recipient site is helpful to select healthy vessels. Anastomosis is performed outside the zone of injury, and a patency test is performed after anastomosis to substantiate adequate blood flow. If a healthy vessel is repaired with a technically satisfactory anastomosis, without tension, and if attention is given to meticulous hemostasis, careful skin closure, and nonconstricting dressings, postoperative management will be easy. Surgeons who are less conscientious in these matters will become more familiar with difficult postoperative management problems. With comprehensive postoperative care of the patient, including repeated monitoring with both clinical evaluation and monitoring devices, arterial or venous insufficiency can be detected early. If the cause of the vascular compromise is identified and corrected rapidly, the failing free tissue transfer can often be saved.  相似文献   

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