微血管吻合器在头颈部游离皮瓣移植动脉吻合中的初步应用

目的 探讨在头颈部缺损游离皮瓣移植手术中应用微血管吻合器吻合动脉的可靠性。方法 选择2013—2014年间行游离皮瓣修复头颈部肿瘤切除后缺损的患者21例,分别采取腓骨肌皮瓣、股前外侧皮瓣、前臂皮瓣同期修复缺损。动脉均采用微血管吻合器做端-端吻合,动脉吻合共应用21枚吻合器,观察其吻合时间及吻合后血管通畅情况。结果 21例患者术中吻合口均通畅无渗血;1例于术后第1天因皮瓣苍白行手术探查,术中见动脉血栓形成,重新行手工吻合,吻合后血管通畅。应用吻合器吻合时间较手工缝合明显缩短,平均约4~6 min。结论 微血管吻合器在适宜情况下可用于头颈部缺损游离皮瓣修复中的动脉端-端吻合,能够明显缩短吻合时间,操作简便,吻合质量可靠。

Application of microvascular coupling device for arterial anastomosis in head and neck reconstruction

PURPOSE: The purpose of this study was to investigate the efficacy of microvascular coupler for arterial anastomosis in head and neck reconstruction during a 2-year period at the Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital. METHODS: Twenty-one cases of microvascular free flaps from October 2013 through December 2014 were retrospectively reviewed. Flap survival and thrombosis of the arterial anastomoses were determined in these cases. RESULTS: A total of 21 consecutive patients underwent microsurgical head and neck reconstruction, including 7(33.33%) radial forearm, nine(42.86%) fibular and 5(23.81%) anterior lateral thigh free flaps. There was 1 complication related to arterial thrombosis in this series, requiring surgical reexploration and a sutured anastomosis was performed. There were no complications related to technical performance of the coupling device. CONCLUSIONS: Use of a coupler device shows reliability for arterial anastomosis in head and neck reconstruction. With proper vessel selection and sufficient experience using the microvascular coupler, arterial coupling may be performed in an expeditious, safe, and reliable fashion with minimal morbidity. Though not commonly practiced, use of coupling device for arterial anastomosis can significantly save time, which is a viable alternative to sutured anastomosis.