CAJ | 학술논문

目的通过游离皮瓣病例的回顾性研究,寻找发现皮瓣手术过程存在的问题并分析其原因,找出预防、解决方法,为同道提供参考. 方法对2000年10月至2010年10月间在本院治疗的1270例游离皮瓣、肌皮瓣及穿支皮瓣病案资料回顾性研究,其中对722例进行随访研究,随访时间6个月～5年.从皮瓣设计、切取、移植、供受区的处理以及修复后功能等几个方面找寻存在的问题和缺陷,逐项分析原因,并根据临床经验和教训,提出预防及应对的措施和方法. 结果 1270例皮瓣,因故放弃和失败64例,成功率为95.0％,术后皮瓣坏死率为3.8％.发生血管危象76例,其中动脉危象42例,静脉危象34例,经局部保守处理挽救55例,手术挽救成功15例,5例部分成活,失败7例.本组急诊皮瓣手术682例,感染率仅为4.7％.慢性创面588例,感染率为8.8％.慢性创面感染率远高于急诊创面.结论预防和及时处理血管危象是保障皮瓣成活的关键.严格遵守皮瓣切取原则,控制好修饰性切取适应证,注意皮瓣张力是皮瓣手术的技术要求.手术供区正确封闭处理方式,是预防、解决并发症及功能不良的有效方法.
목적 통과유리피판병례적회고성연구,심조발현피판수술과정존재적문제병분석기원인,조출예방、해결방법,위동도제공삼고. 방법 대2000년10월지2010년10월간재본원치료적1270례유리피판、기피판급천지피판병안자료회고성연구,기중대722례진행수방연구,수방시간6개월～5년.종피판설계、절취、이식、공수구적처리이급수복후공능등궤개방면조심존재적문제화결함,축항분석원인,병근거림상경험화교훈,제출예방급응대적조시화방법. 결과 1270례피판,인고방기화실패64례,성공솔위95.0％,술후피판배사솔위3.8％.발생혈관위상76례,기중동맥위상42례,정맥위상34례,경국부보수처리만구55례,수술만구성공15례,5례부분성활,실패7례.본조급진피판수술682례,감염솔부위4.7％.만성창면588례,감염솔위8.8％.만성창면감염솔원고우급진창면.결론 예방화급시처리혈관위상시보장피판성활적관건.엄격준수피판절취원칙,공제호수식성절취괄응증,주의피판장력시피판수술적기술요구.수술공구정학봉폐처리방식,시예방、해결병발증급공능불량적유효방법.
Objective Evaluate data of 1270 cases with free flap transplant,to find the problems in the process of operation,and then to analyse its causes and how to prevent and solve it,as well as providing reference for clinical colleagues. Methods To study 1270 cases of free flaps,musculocutaneous flap and perforator flap who was treated in our hospital from October 2000 to October 2010 retrospectively. A total of 722 cases of the group were followed-up 6 months to 5 years. To detective and search the problems and imperfection from designing,harvesting,tranfer,to the management and function of donor site after free flap transplantion.And also to analysis the couse of problems and operation failure,discuss the conclude of and to provide advisable measure. Results Total 1270 free flaps were transplanted successfully except 64 can-celled or failured for some reason, the success rate was 95.0％, the postopertive necrosis rate was 3.8％.Seventy-six cases were encountered vascular complications venous crisis in 42,arterial crisis in 38.Fifty-five cases were saved successfully without surgery,and 15 cases survived completely by vessel explorative operation. Five cases were partial necrosis and 7 cases necrosis. The rate of postoperative infection of emergency cases and chronic one were 4.7％ (682 cases)and 8.8％(588 cases) which show the infective incidence of latter was higher than former. In addition, there were many other problems were found such as distal flaps necrosis,contracture,deformation,impairment function of doner site,etc. Conclusion Preventing and management timely to vessle crisis is the key to flap suvive. The principle of dissecting flap should be followed strictly,and control the indications of modified processing during flap harvest,keep the proper flap tension were technical requirements in flap transplantion. Right way of donor site closed and management of insufficient timely were equally important to prevent and solve to complications and dysfunction.