《Journal of Oral and Maxillofacial Surgery》 ›› 2016, Vol. 26 ›› Issue (5): 358-. doi: 10.3969/j.issn.1005-4979.2016.05.011

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Analysis of Necrotic Complications of Anterolateral Thigh Free Flap in Reconstructive Surgery of the Face

CHEN Yu-ting, LI Shu-guang, WEI hai-gang   

  1. Department of Oral and Maxillofacial Plastic Surgery, Foshan Hospital, Southern Medical University
  • Received:2016-04-11 Revised:2016-05-14 Online:2016-10-28 Published:2017-06-30

分析及预防和处理措施

陈玉婷,李蜀光,魏海刚   

  1. 南方医科大学附属佛山医院口腔颌面整形外科
  • 通讯作者: 陈玉婷,主治医师. E-mail: zqchenyuting@126.com E-mail:zqchenyuting@126.com
  • 作者简介:陈玉婷(1981—),女,广东肇庆,硕士,主治医师.
  • 基金资助:

    佛山市科技创新平台项目(2013AG10012)

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

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

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