摘要：  目的：探讨使用游离桡侧前臂皮瓣进行颌面部缺损修复时，采用浅静脉回流与深、浅静脉回流对于皮瓣危象发生率、皮瓣存活率的影响。方法：选择1991?鄄01—2011-１1完成的，183例采用游离桡侧前臂皮瓣（RFFF）修复口腔颌面部缺损的患者作为研究对象。按照皮瓣回流静脉分为2组：深浅静脉回流组（组Ⅰ，85例）、浅静脉回流组（组Ⅱ，98例）。分析肿瘤的部位和类型、皮瓣回流静脉的选择、皮瓣成活情况及皮瓣危象发生情况。结果：组Ⅰ中皮瓣危象的发生率（8/85）与组Ⅱ中皮瓣危象发生率（6/98）没有显著统计学差异（χ2检验，P=0.40）。 组Ⅱ中，吻合2条浅静脉和吻合1条浅静脉的病例，血管危象的发生率分别为2/27 和 4/71，但差异没有统计学意义(Fisher检验，P=0.67）。单静脉吻合与双静脉吻合的病例中，血管危象的发生率分别为4/71 和 10/112，但差异没有统计学意义（χ2检验，P=0.41）。术后组Ⅰ皮瓣存活率96.47%（82/85），组Ⅱ皮瓣存活率为100%（98/98），2组在存活率上没有显著差异（Fisher检验，P=0.0983），术后皮瓣的总成活率为98.36%(180/183)。结论：浅静脉回流在解剖上及技术上都是可靠的，单纯吻合一条浅静脉不影响皮瓣存活率。

关键词: 桡侧前臂皮瓣, 头静脉, 桡静脉, 静脉栓塞, 皮瓣危象

Abstract: Objective: This study aimed to investigate whether the failure rate of forearm free skin flap are related to venous drainage in locations at different levels within the flap.  Methods: 183 radial forearm free flaps for oral and maxillofacial surgical defect reconstruction from Jan 1991 to Nov 2011 were retrospectively analyzed and assigned to two groups. Group Ⅰ(n=85), superficial and deep both venous drainages were established in the flap. Group Ⅱ(n=98), only superficial venous drainage were anastomosed.  Analysis data including：the location and type of tumor, position of the drainage vein of free flap, the survival rate of free flap and incidence rate of flap compromises.  Results: No statistical differences in venous problems between group Ⅰ and group Ⅱ were performed(8/85 vs 6/98, Chi-Square Test, P=0.4). In group Ⅱ, cases with two superficial venous anastomoses showed a slight higher incidence of venous problems than  one superficial venous anastomosis cases,  but the difference was not significant (2/27 vs 4/71, Fisher's exact test, P=0.67). However, all cases with one venous anastomosis showed a slight lower incidence of venous problem than all cases with two venous anastomoses, and without significant difference(4/71 vs 10/112, Chi- Square Test, P=0.41）. In the postoperative period, the flap survival rate in group Ⅰ was 96.47%(82/85), while it was 100%(98/98) in group Ⅱ，and without a significant difference(Fisher's exact test, P=0.0983). The total survival rate was 98.36%(180/183). Conclusion: Superficial venous drainage in radial forearm free flap is reliable both in anatomical and technical considerations. Only cephalic venous anastomosis could shorten the time of surgery.

Key words: radial forearm flap, cephalic vein, radial vein, flap compromise, venous thrombosis

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• R782.26