CAJ | 학술논문

目的分析预构皮瓣修复头面部瘢痕术后水肿的性质并监测预构皮瓣术后水肿的转归. 方法自2011年1月至2015年3月,入选预构皮瓣术后水肿患者18例,持续随访5个月.通过B超检测和吲哚菁绿荧光造影分析预构皮瓣术后水肿性质.监测预构皮瓣术后淋巴水肿的转归情况,即淋巴系统重建及再通过程:包括大体观察皮瓣术后肿胀变化;使用B超监测皮瓣水肿程度;ICG(吲哚菁绿荧光成像)监测皮瓣内淋巴水肿程度变化;ICG监测淋巴系统重建与再通情况. 结果患者于术后ld起出现皮瓣凹陷性水肿,B超及ICG提示为轻度淋巴水肿7例,中度淋巴水肿10例,重度淋巴水肿1例.术后皮瓣内淋巴水肿程度逐渐减轻,术后3～6d内缓解最快,术后12d起趋于稳定.ICG荧光造影示术后3周起皮瓣淋巴水肿程度减轻;皮瓣内淋巴管运输能力逐渐恢复,术后3～6d改善最明显;术后6d发现预构皮瓣内淋巴微循环与受区再通;淋巴系统沿淋巴结方向重建;术后2个月形成集合淋巴管;术后5个月重建淋巴系统成熟. 结论预构皮瓣术后存在淋巴管阻塞,会发生短暂性淋巴水肿,水肿发生率较高;皮瓣淋巴回流系统在术后6d内可发生再通,主要沿淋巴结方向重建;术后2～3周左右,水肿大部分消退且趋于稳定;预构皮瓣内淋巴系统重建及淋巴管与受区再通对水肿消退起重要作用;5个月后重建淋巴系统成熟.
목적 분석예구피판수복두면부반흔술후수종적성질병감측예구피판술후수종적전귀. 방법 자2011년1월지2015년3월,입선예구피판술후수종환자18례,지속수방5개월.통과B초검측화신타정록형광조영분석예구피판술후수종성질.감측예구피판술후림파수종적전귀정황,즉림파계통중건급재통과정:포괄대체관찰피판술후종창변화;사용B초감측피판수종정도;ICG(신타정록형광성상)감측피판내림파수종정도변화;ICG감측림파계통중건여재통정황. 결과 환자우술후ld기출현피판요함성수종,B초급ICG제시위경도림파수종7례,중도림파수종10례,중도림파수종1례.술후피판내림파수종정도축점감경,술후3～6d내완해최쾌,술후12d기추우은정.ICG형광조영시술후3주기피판림파수종정도감경;피판내림파관운수능력축점회복,술후3～6d개선최명현;술후6d발현예구피판내림파미순배여수구재통;림파계통연림파결방향중건;술후2개월형성집합림파관;술후5개월중건림파계통성숙. 결론 예구피판술후존재림파관조새,회발생단잠성림파수종,수종발생솔교고;피판림파회류계통재술후6d내가발생재통,주요연림파결방향중건;술후2～3주좌우,수종대부분소퇴차추우은정;예구피판내림파계통중건급림파관여수구재통대수종소퇴기중요작용;5개월후중건림파계통성숙.
Objective Currently, the prefabricated flap is used for reconstructing the post-burn scar in head and face.The aim is to analyze the nature of the post-op edema in the prefabricated flaps, to determine whether it is lymphedema, and to study the prognosis of the edema.Methods From January, 2011 to March, 2015, 18 cases of post-operation edema in superficial temporal fascia prefabricated flaps were studied and each case was followed for 5 months.We used ultrasound and indocyanine green (ICG) fluorescent imaging to study the nature of the edema.Apart from that, we monitored the recovery process of the post-operation edema by a) measuring the horizontal diameter of the flap by a tape, b) measuring the thickness of the flap by the ultrasound, c) monitoring the condition of edema by ICG and d) monitoring the reconstruction and recanalization of the lymphatic system by ICG.Results Pitting edema always occurred in the prefabricated flap from the first day after operation.These patients were diagnosed as mild lymphedema (7 cases), moderate lymphedema (10 cases), and severe lymphedema (1cases) by ultrasound and ICG florescent imaging.The degree of flap lymphedema improved gradually and it improved significantly from 3 days to 6 days post-op eration.The condition of flap lymphedema became stable from the 12 days post-operation.The fluorescence image of ICG showed that the stage of flap lymphedema improved from 3 weeks post-operation and the transportation capability of lymphatic vessels increased most from the 3 days to 6 days post-op eration.We also found lymphatic vessels reconnected from the 6 days post-operation and lymphatic system reconstructed following the direction to lymph nodes.We could discover the collecting lymphatic vessels from 2 months post-operation and the lymphatic system in prefabricated flap matured from 5 months post-operation.Conclusion The post-operation edema in the prefabricated flaps is lymphedema, the incidence rate of which is high.The lymphatic drainage system recovers in 6 days after the operation.It is reconstructed along the lymph nodes.The edema disappears in 2-3 weeks post-operation, the reconstructed the lymph system matures in 5 months.