摘要
目的：探讨游离翻转静脉筋膜瓣覆盖创面后自身组织成活情况、血管吻合口通畅情况及对创面深部组织保护的效果三方面与规定时间段的关系。方法2011年3月-2014年6月，运用游离翻转筋膜瓣临时覆盖手部创面的方法成功救治了伤情较重的病例25例。将游离翻转筋膜瓣覆盖创面术后的4，7，10 d作为参考时间段，将病例分成A，B，C三组。通过临床观察翻转筋膜瓣在不同时段的以下几个指标：⑴自身组织成活及坏死的层次。⑵游离翻转筋膜瓣静脉吻合口通畅情况。⑶创面深部受保护组织的血运情况。结果术后4d时静脉筋膜瓣组织暗红，未见明显坏死；术后7d时翻转筋膜瓣靠创面侧血运基本良好，远离创面侧组织发黑坏死；术后10 d时翻转筋膜瓣全层组织坏死2例，大部分坏死4例，少部分组织坏死1例。三组病例血管吻合口均通畅良好，未见一例栓塞。三组中创面深部受保护组织如骨质、肌腱、神经等湿润度良好，血运良好。结论在适当的时间范围内，使用游离翻转筋膜瓣临时覆盖创面既可对失血组织重建血运、又可以保护深部重要组织，是各种创面良好的生物覆盖材料，相当于带血供的负压封闭引流技术（vaccum sealing drainage, VSD）。
Objective To investigate the relationship between three aspects of the effect of the self-tissue survival rate, the patency of the vascular anastomosis and the protection of the deep tissue of the wound with specified duration. Methods From March 2011 to June 2014, 25 cases with severe injuries were successfully treated by the method of free reversed fascial flap in the treatment of hand wound in our clinique. The cases were divided into A, B, C three groups by free flap covering 4, 7 and 10 days after operation. Observing several indicators through the clinical observation of the reversed fascial flap in different periods：1 the level of their own survival and necrosis of tissue. 2, the vein anastomosis patency of free flap. 3, the blood circulation of the deep wound with protected tissue. Results 4 days after operation venous fascial flap was dark red without obvious necrosis; 7 days after operation, reversed flap by side wound and the blood transport was basically good, while distance and lateral wound tissue was black necrosis; after 10 days, the full-thickness tissue necrosis of fascial flap was observed in 2 cases, partial necrosis in 4 cases, less tissue necrosis in 1 case. Three groups of patients with vascular anastomosis were well, no embolism case was found. In the three groups of cases, the wound was protected by the protection of tissues such as bones, tendons, nerves and so on. Conclusion In the appropriate time, using free reverse fascial flap temporary cover the wound not only as a blood tissue reconstruction of blood transport, but also for the use of coverage of the deep tissue, which is also used as good biological mulching materials, with respect to VSD with blood supply.
出处
《实用手外科杂志》
2016年第3期251-254,共4页
Journal of Practical Hand Surgery
基金
中山市卫生局科研项目（项目编号：2013A020198）
关键词
游离筋膜瓣
静脉筋膜瓣
翻转筋膜瓣
创面覆盖
Free fascial flap
Venous fascial flap
Reversed fascial flap
Wound coverage
