两个游离皮瓣臂动脉端侧吻合修复单动脉上肢

Michael J. Stein, Jing Zhang
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引用次数: 1

摘要

摘要背景一名36岁男性发生机动车事故,表现为上肢Guistillo's IIIB挤压伤。严重粉碎性尺骨骨折导致10厘米的骨缺损,并伴有明显的软组织损伤。方法大范围损伤,肘部侧支血管不足,远端生存能力依赖肱动脉。应用游离腓骨皮皮瓣和筋膜皮股前外侧皮瓣端侧与肱动脉吻合重建缺损。结果成功抢救上肢,术后第10天出院。在2年的随访期间,两个游离皮瓣均存活,无供体或受体并发症。结论:该病例说明了在大范围损伤中受体血管不足的重大Guistillo’s IIIB损伤所固有的挑战。虽然在损伤区外进行吻合是首选,但本病例展示了在损伤区内以端侧方式对肱动脉进行多次吻合的成功。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Single Artery Upper Extremity Salvage with Two Free Flap End-to-Side Brachial Artery Anastomoses
Abstract Background A 36-year-old male was involved in a motor vehicle accident, presenting with a Guistillo's IIIB crush injury to the upper extremity. A severely comminuted ulnar fracture resulted in a 10-cm bone defect with significant overlying soft tissue injury. Methods The injury resulted in a wide zone of injury with inadequate collateral vascularity at the level of the elbow and distal viability dependent on the brachial artery. An osteocutaneous free fibular flap and fasciocutaneous anterolateral thigh flap were used to reconstruct the defect with both flaps anastomosed in an end-to-side fashion to the brachial artery. Results The upper extremity was successfully salvaged, and the patient discharged from hospital at postoperative day 10. Both free flaps survived with no donor or recipient site complications at a follow-up period of 2 years. Conclusion The case illustrates the challenges inherent to significant Guistillo's IIIB injuries with insufficient recipient vessels over a large zone of injury. While performing anastomoses outside the zone of injury is preferred, this case demonstrates the success of performing multiple anastomoses to the brachial artery in an end-to-side fashion within the zone of injury.
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