头颈部游离组织瓣血管危象的预防和处理

目的探讨头颈部游离组织瓣术后血管危象的预防和处理方法。方法2003年3月～2008年4月我科96例游离组织瓣移植术后危象发生13例。回顾性分析危象发生时间,危象类型,皮瓣类型,吻合血管选择,血栓病理观察,处理过程和抢救成功率。结果13例中,保守处理成功5例。剩下8例中,动脉危象为1例,静脉危象6例,动静脉危象1例;前臂瓣2例,腹直肌3例,股外侧皮3例。首次发生危象时间分别在术后2小时～6天,平均34小时。8例中,4例系连续两次抢救,最终抢救成功4例,失败4例。结论术前认真选择适应证和规范的吻合技术是减少危象的关键;早期发现和掌握抢救技巧提高抢救成功率的关键。

Prevention and management of vascular crisis in free tissue flaps of the head and neck region

OBJECTIVE To analyze the clinical manifestation,outcome of vascular crisis in the free tissue flaps of the head and neck region.METHODS A total of 96 cases with defect of head and neck region were repaired with free tissue flaps from March 2003 to May 2008.Thirteen of them presented vascular crisis.The occurring time,crisis type,choosing of anastomosed vessel,thrombus pathology,management and outcome were analyzed.RESULTS In all of the 13 cases,the flaps in 5 cases survived after conservative treatment. The other 8 cases included 2 cases of forearm flaps,3 cases of rectus abdominis flaps and 3 cases of lateral femoral flaps.There were 2 patients with arterial crisis, 5 patients with venous crisis and 1 patient with arterial and venous crisis.The first crisis time was observed from 2 to 180 hours after operation with an average time of 34 hours.Among the 8 cases,4 received twice consecutive salvages and 4 cases were successful. CONCLUSION The key point of the successful free tissue flap transplantation includes strict indication selection,standard micreanastomosis,and the correct salvage strategy for the crisis.