CAJ | 학술논문

目的对3例拇手指再造供区(足母)趾坏死的原因进行分析并提出预防措施.方法自1998年2月至2005年2月,在我院行游离足趾移植再造拇手指中,3例供区(足母)趾部分坏死.通过分析(足母)趾血供的来源及术中采用血管阻断实验,分析供区(足母)趾部分坏死的原因,提出预防措施.结果 3例供区(足母)趾部分坏死,第1跖骨背动脉均为Ⅲ型,术中均采用足背动脉-足底深动脉-第1趾足底总动脉这一途径来切取第2趾.发现供区(足母)趾坏死时间为术后8～21 h.术中同时损伤(足母)趾腓侧趾背动脉、腓侧跖底动脉,将严重影响供区(足母)趾血液循环,术后供区包扎过紧、观察不到位,是导致供区(足母)趾坏死不可忽视的原因.结论第1跖骨背动脉Ⅲ型,解剖足底动脉于跖底的"X"形交叉处,切取第2足趾,更易影响供区(足母)趾血运.采用吻合足底深动脉与跖底动脉或足背动脉-第2跖背动脉-趾动脉为血供切取足趾,可有效预防供区(足母)趾血运被破坏;术中、术后严密观察供区足的血运情况,及时解除(足母)趾压迫,是预防供区(足母)趾坏死的有效途径.
목적 대3례무수지재조공구(족모)지배사적원인진행분석병제출예방조시.방법 자1998년2월지2005년2월,재아원행유리족지이식재조무수지중,3례공구(족모)지부분배사.통과분석(족모)지혈공적래원급술중채용혈관조단실험,분석공구(족모)지부분배사적원인,제출예방조시.결과 3례공구(족모)지부분배사,제1척골배동맥균위Ⅲ형,술중균채용족배동맥-족저심동맥-제1지족저총동맥저일도경래절취제2지.발현공구(족모)지배사시간위술후8～21 h.술중동시손상(족모)지비측지배동맥、비측척저동맥,장엄중영향공구(족모)지혈액순배,술후공구포찰과긴、관찰불도위,시도치공구(족모)지배사불가홀시적원인.결론 제1척골배동맥Ⅲ형,해부족저동맥우척저적"X"형교차처,절취제2족지,경역영향공구(족모)지혈운.채용문합족저심동맥여척저동맥혹족배동맥-제2척배동맥-지동맥위혈공절취족지,가유효예방공구(족모)지혈운피파배;술중、술후엄밀관찰공구족적혈운정황,급시해제(족모)지압박,시예방공구(족모)지배사적유효도경.
Objective To analyze the causes of necrosis of the donor great toe in 3 cases of toe-to-hand transfer and propose the proper preventive measures.Methods Among all the toe-to-hand transfers done from February 1998 to February 2005, partial necrosis of the donor great toe occurred in 3 cases.Blood supply of the transferred toe and the intraoperative vessel occlusion test was reviewed and analyzed to define causes of the necrosis, and propose preventive measures accordingly.Results The dorsal artery of the great toe was type Ⅲ in all 3 cases.Intraoperatively the second toe was harvested based on the dorsalis pedis artery, deep plantar artery, plantar artery of the first toe.Donor great toe necrosis was observed 8 to 21 hours postoperatively.Intraoperative inadvertent injury of the dorsal great toe fibular artery and fibular plantar metatarsal artery, tight dressing of the donor site after the surgery, and poor postoperative monitoring could have contributed to the toe necrosis.Conclusion Type Ⅲ of the dorsal artery of the great toe, anatomical X cross and resection of the second toe could easily affect blood supply to the donor great toe.Anastomosis of the deep plantar artery and the plantar metatarsal artery, or harvest of the toe based on the dorsalis pedis artery, second dorsal metatarsal artery,digital artery axis can effectively prevent damage of the blood flow.Intra-and post-operative close monitoring of the donor site circulation and timely decompression of the great toe were effective ways to prevent great toe necrosis.