吻合血管外露小创面植皮术16例临床研究

中华显微外科杂志 Pub Date : 2019-12-25 DOI:10.3760/CMA.J.ISSN.1001-2036.2019.06.005

Wei Yitao, Mei Xiongjun, Wu Renjuan, Zhong Guiwu, Liang Haihua, Sun Fangqin

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引用次数: 1

摘要

目的报道血管吻合外露小创面植皮的临床效果。方法2011年1月~ 2018年5月对16例吻合血管外露的小创面采用全层植皮术治疗。其中再植4例，重建9例，皮瓣移植3例。手上有十三处伤口，脚上有三处。血管吻合后，创面留下3条动脉吻合口、9条静脉吻合口和4条动静脉吻合口。伤口暴露动脉大小0.8 ~ 2.3 mm，平均1.0 mm。伤口外露静脉大小0.8 ~ 2.5 mm，平均1.2 mm。软组织缺损面积1.0 cm×1.5 ~ 2.6 cm×6.0 cm，皮肤移植面积1.0 cm×1.5 ~ 2.6 cm×6.0 cm。移植皮肤不包覆，不加压。直接缝合供区。术后随访观察术后效果。结果14例植皮完全成活，1例局部成活，经肢体固定及换药后愈合，1例发生坏死。随访6 ~ 24个月，平均14.4个月。最后随访时采用CDU、HHD或CTA。吻合血管通畅15例，栓塞1例。移植皮肤未见色素沉着。所有移植皮肤柔软，可穿戴，7-10 mm处有两点辨别。移植皮肤能感觉到吻合动脉的脉搏。在供体部位只留下了线状疤痕。结论血管吻合外露的小创面全层植皮手术操作简单，成活率高。手术效果满意。吻合血管暴露不影响吻合血管通畅，具有相当的临床价值。关键词:全层植皮;皮肤移植;吻合血管暴露;伤口;修复

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Clinical study of skin grafting in small wounds with anastomotic vascular exposure: report of 16 cases

Objective To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis. Methods From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting. Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anastomoses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds. Sizes of artery exposed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured. Postoperative follow-up was conducted to observe the postoperative effect. Results Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites. Conclusion The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values. Key words: Full-thickness skin graft; Skin grafting; Anastomotic Vascular exposed; Wound; Repairing

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来源期刊

中华显微外科杂志

CiteScore

0.50

自引率

0.00%

发文量

6448

期刊介绍： Chinese Journal of Microsurgery was established in 1978, the predecessor of which is Microsurgery. Chinese Journal of Microsurgery is now indexed by WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 1.731 in 2017, ranking the third among all journal of comprehensive surgery. The journal covers clinical and basic studies in field of microsurgery. Articles with clinical interest and implications will be given preference.