监测皮岛对深部移植组织瓣血供监测的可靠性研究

目的：评价监测皮岛对深部移植组织瓣血供监测的可靠性。方法：从1989年9月到2003年6月，对85例因肿瘤切除、创伤导致深部组织缺损的病人实施了携带监测皮岛的各种深部游离组织瓣移植修复，术后7d内连续临床观察监测皮岛以了解深部组织瓣的血供。结果：10例监测皮岛出现异常，探查发现真正血栓9例，1例为假阳性。术后3d内出现9例，3d后(术后第5d)出现1例。监测皮岛对深部移植组织瓣血供监测的敏感性、特异性和Youden’s指数(正确诊断指数)分别为100％，98．7％和0．987。结论：(1)监测皮岛能可靠地监测深部移植组织瓣的血供状态；(2)应用监测皮岛，对深部移植组织瓣的血供监测3d是足够的。

The reliability of monitoring-flaps for the circulatory monitoring of buried free tissue grafts

Objective: To evaluate the reliability of monitoring-flaps for the circulation monitoring of buried free tissue grafts. Methods: Combining with a monitoring-flap, 85 various buried free tissue grafts were treated in 85 patients with tissue defects for tumor resection or trauma from Sept. 1989 to June 2003. All of the monitoring-flaps were designed according to vascular anatomic characteristics and harvested by microsurgical technology. In order to observe the blood supply of the buried free tissue grafts, the 7 days' continuously clinical examination including the color, degree of turgor, temperature, capillary refill, and bleeding of the monitoring-flaps were taken postoperatively. If any of the items were abnormal, the circulation of the buried free tissue graft was regarded as in danger and some measures such as re-operation should be taken immediately to save the buried graft. Results: The monitoring flap abnormalities in all were indicated in 10 flaps,nine case monitoring-flaps were abnormal within 3 days while another 1 case over 3 days postoperatively. Immediate revisions were performed on the pedicle of the monitoring-flap and the buried free tissue grafts. Among these 10 grafts, nine showed true thrombosis and one was false-positive. Among the above nine flaps, seven were salvaged and two were finally abandoned. The total thrombosis rate was 10.6 percent (9 cases of 85). The salvage rate was 80 percent. The x2 value was only 0.059, has no significance of the buried free tissue grafts between within 3 days and 7 days postoperatively. The sensitivity, specificity, and Youden's index of monitoring-flaps was 100%, 98.7%, and 0.987 respectively. Conclusions: (1) The monitoring-flaps for the circulation monitoring of buried free tissue grafts are reliable. (2) Three days' clinical observation may be sufficient for evaluating the circulation of the buried free grafts.