摘要： 目的：分析股前外侧皮瓣坏死的原因及有效预防和处理措施。方法：回顾分析我院2011-01— 2015-12期间，54例股前外侧皮瓣游离移植修复颌面部缺损的临床病例中，失败病例的详细资料，寻找可能导致游离股前外侧肌皮瓣坏死的原因。结果：54例股前外侧皮瓣修复病例中有12例发生坏死，其中有2例全部坏死，10例部分坏死；1例因术中发现股前外侧皮瓣供血动脉发生变异，导致皮瓣全部坏死，1例因术后发生血管危象抢救失败导致全部坏死，其余10例部分坏死病例中，9例为静脉性栓塞，1例为动脉性栓塞，经重新打开吻合血管清除血栓后部分存活。在经处理后皮瓣存活的病例中，6例伴有糖尿病，血糖波动明显，2例为高血压，血管粥样硬化明显，2例为放疗后患者。结论：术前积极处理基础疾病，熟悉股前外侧皮瓣的走形，术中熟练掌握吻合血管技巧，术后仔细观察和护理，是减少股前外侧皮瓣坏死的重要措施。

关键词: 游离皮瓣, 坏死, 组织缺损

Abstract: Objective: To  analyze  the  aetiology and pathogenesis of necrotic complications of anterolateral thigh free flap in reconstructive plastic surgery of the face, and its preventive measures. Methods: A retrospective analysis was conducted on patients reporting to our hospital. A total of  54 consecutive patients from December 2015 to January 2011 were included. Results: 12 cases of necrotic complications presented in the anterolateral thigh free flaps (12/54=22.2%), of which 2 cases were total necrosis, and 10 cases were partial necrosis. After further analysis, in 1 case, the blood supply artery of the anterolateral femoral flap was found to be variant, which resulted in the total necrosis of the flap; the other case with postoperative vascular crisis lead to failure. The remaining 10 cases showed partial necrosis, 9 cases caused by venous thrombosis, 1 case caused by arterial embolism with partial survival after rescue measures. Among the 10 cases, 6 patients were accompanied with diabetes mellitus and significant fluctuations in blood glucose levels, 2 patients suffered with atherosclerotic hypertension. 2 patients were treated with radiotherapy. Conclution: Thorough examination and active treatment of the underlying diseases of the donors before transplantation surgery, is an important measure to reduce the necrosis risks.

Key words:  , free flaps, necrosis, tissue defect

中图分类号: 

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• R782.2