游离腓骨复合瓣皮岛在移植后血供监测中的作用及血管危象的处理

目的 探讨游离腓骨复合瓣皮岛在移植后血供监测中的作用.方法 回顾研究1999年5月至2007年9月期间完成的714例游离腓骨复合瓣移植病例,分析术后出现血管危象的病例及其处理方法.结果 本组23例游离瓣术后发生血管危象,其中静脉危象17例,动脉危象6例.17例静脉危象中,14例有皮岛颜色的改变,另外3例尚未出现皮岛颜色的改变.有皮岛颜色改变的14例中,6例经抢救游离腓骨复合瓣获得成活,8例未能成功.无皮岛颜色改变的3例经抢救获均得成功.6例动脉危象中,5例有皮岛颜色改变者抢救未成功,而1例无皮岛颜色改变的腓骨瓣经抢救成功.本组游离瓣术后血管危象的发生率为3.2%(23/714),抢救成功率为43.5%(10/23),游离瓣的临床成活率为98.2%(701/714).结论 虽然皮岛是游离腓骨复合瓣移植术后血供监测的可靠方法,但是单纯观察皮岛颜色的改变并不能早期发现术后的血管危象.

Reliability of skin paddle in monitoring blood flow after free fibular osteocutaneous composite flap transfer

Objective To evaluate the reliability of skin paddle in monitoring blood flow after free fibular osteocutaneous composite flap transfer.Methods Seven hundred and fourteen consecutive cases of mandibular or maxillary reconstruction using free fibular flap from May 1999 to September 2007 were reviewed.The cases with postoperative vessel thrombosis were analyzed.Results Postoperative vessel thrombosis occurred in 23 cases,17 were venous and 6 arterial.Among 14 cases of venous thrombosis with color change of skin paddles,only 6 were successfully salvaged,but 3 cases with no color change of skin paddles were all successfully salvaged.For arterial thrombosis.only one flap was successfully salvaged.The postoperative vessel thrombosis rate was 3.2%,and the salvage rate was 43.5%.The overall successful rate of free fibula flap was 98.2%.Conclusions Postoperative vessel thrombosis can not be detected in the early stage if only observing the color change of skin paddle after free fibula flap transfer.