预制减压型静脉动脉化皮瓣的临床应用

目的　探讨应用调节皮瓣载荷理论对静脉动脉化皮瓣进行预制减压处理的临床应用效果。 方法　2016 年1月至2017年5月，对临床上24例手指皮肤软组织缺损患者应用预制减压型静脉动脉化皮瓣，皮瓣切取面积最大6.0 cm × 4.0 cm，最小2.0 cm×2.0 cm，术后应用激光闪斑多普勒血流成像仪在不同时间段测量皮瓣血流灌注量，观察皮瓣成活质量及修复效果。 结果　术后24例静脉动脉化皮瓣全部成活，其中1例皮瓣远端出现水疱及皮下瘀血，其余23例皮瓣均无明显水疱形成，无明显肿胀，皮瓣血流灌注量观测发现术后72 h稳定并趋近于生理灌注水平。经过3~24个月随访，发现皮瓣外观满意，质地良好，成活质量好。 结论　预制减压型静脉动脉化皮瓣在静脉回流不充分的情况下，可调节皮瓣的灌注量与回流量达到平衡，进而提高皮瓣成活质量，达到精细修复手部皮肤缺损创面的要求，值得临床推广。

The clinical application of prefabricated-decompression arterialized vein flap

Objective　To investigate clinical effects of prefabricated-decompression arterialized vein flap. Methods　From January 2016 to May 2017, 24 cases of soft tissue defects of fingers and thumbs were repaired with the prefabricated-decompression arterialized vein flap. The flaps ranged from 2.0cm×2.0 cm to 6.0 cm × 4.0 cm. The perfusion volume of the flaps was measured by the laser flash spot doppler blood flow imaging instrument. Results 24 flaps survived completely, only 1 flap suffered partial margin blister and ecchymoma. No blister and swelling were found in the other 23 flaps. Patients were followed up for 3 to 24 months. The appearance of flaps was satisfactory and the texture was soft and good. Conclusion　There is a significant effect by using the prefabricated-decompression arterialized vein flaps, which has a reduced lead through a better balance of perfusion and drainage. With prefabricated-decompression adjustment, the survival rate and quality of the flaps can improved significantly.