CAJ | 학술논문

目的探讨吻合一组血管的联合皮瓣的应用价值. 方法本组36例均为车祸伤,损伤部位在膝、小腿或踝足部、上肢.创面超大,皮肤缺损伴骨关节、肌腱裸露,选用吻合一组血管的联合皮瓣修复,其中吻合肩胛下血管肩胛—侧胸联合皮瓣7例,最大为70 cm×10 cm；吻合肩胛下血管侧胸—背阔肌联合皮瓣9例,最大为42 cm×24 cm(1008 cm2)；吻合肩胛下血管的肩胛—背阔肌联合皮瓣2例；吻合旋股外侧血管与股外侧皮神经的大腿前内侧—阔筋膜张肌联合皮瓣8例；吻合胫前血管与腓浅神经的踝前—足背联合皮瓣5例；吻合足背血管与腓浅神经的趾伸短肌—足背联合皮瓣5例. 结果随访1.5 ～25.0年,其中有23例随访19年,皮瓣全部成活,创面全部得到覆盖,感染伤口治愈,未再发生溃疡,皮瓣外观好；皮肤恢复了感觉；骨折愈合,保住了肢体,未发生截肢；5例前臂屈肌腱及4例膝关节行松解,为功能恢复创造了条件. 结论吻合一组血管的联合皮瓣能代替吻合多组血管的组合皮瓣,节时、省事,成功率高,拓宽了适应证.
목적 탐토문합일조혈관적연합피판적응용개치. 방법 본조36례균위차화상,손상부위재슬、소퇴혹과족부、상지.창면초대,피부결손반골관절、기건라로,선용문합일조혈관적연합피판수복,기중문합견갑하혈관견갑—측흉연합피판7례,최대위70 cm×10 cm；문합견갑하혈관측흉—배활기연합피판9례,최대위42 cm×24 cm(1008 cm2)；문합견갑하혈관적견갑—배활기연합피판2례；문합선고외측혈관여고외측피신경적대퇴전내측—활근막장기연합피판8례；문합경전혈관여비천신경적과전—족배연합피판5례；문합족배혈관여비천신경적지신단기—족배연합피판5례. 결과 수방1.5 ～25.0년,기중유23례수방19년,피판전부성활,창면전부득도복개,감염상구치유,미재발생궤양,피판외관호；피부회복료감각；골절유합,보주료지체,미발생절지；5례전비굴기건급4례슬관절행송해,위공능회복창조료조건. 결론 문합일조혈관적연합피판능대체문합다조혈관적조합피판,절시、성사,성공솔고,탁관료괄응증.
Objective To explore the value of a set of combined vascular anastomosed flap.Methods The 36 cases were injured,the site of injury in knee and leg or ankle and foot,upper limb.Skin defect with bone and joint,tendon exposure.Selection of anastomosis of blood vessel with large flap,wherein the subscapular vascular anastomosis scapular-lateral thoracic flap in 7 cases,the maximum was 70 cm × 10 cm; anastomosis of subscapular artery lateral thoracic-latissimus dorsi muscle flap in 9 cases,the maximum was 42 cm× 24 cm.Anastomosis of subscapular artery of the scapular-back the latissimus dorsi muscle flap in 2 cases; anastomotic lateral circumflex femoral vessels with lateral femoral cutaneous nerve thigh anterior medial-tensor fascia latae flap in 8 cases; anastomosis of anterior tibial artery and the superficial peroneal nerve in the anterior ankle-dorsal foot flap in 5 cases; anastomosis of dorsal vessels and superficial peroneal nerve of the extensor digitorum brevis muscle-dorsal foot joint flap in 5 cases.Results Following up 8 months to 25 years,twenty-three cases were 19 years.All flaps survived and all the wounds were covered,infection were cured,the skin have aesthesia,fracture healing.Five cases were performed muscle tendon and arthrosis solution for creating conditions for the functional recovery of limb.Conclusion Anastomosis of blood vessel anastomosis combined flap can replace multiple vascular flaps combination,saving,convenient,high success rate,widen the indications.