Al-Benna Sammy, Steinau Hans-Ulrich, Steinstraesser Lars
Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany.
Eplasty. 2009 Jul 30;9:e32.
Reconstructive surgeons are aware that deep vein thromboses can cause a free flap to fail; however, there are no reports in the literature regarding the incidence of free flap failure in the presence of superficial vein thromboses.
A 38-year-old white male patient with poorly controlled type I diabetes mellitus presented with a chronically infected ulcer overlying an osteomyelitic right distal tibia. This region was reconstructed with a musculocutaneous latissimus dorsi free flap.
A superficial vein thrombosis was found 21 cm distant from the venous anastomosis of a free latissimus dorsi myocutaneous flap causing venous congestion. After early exploration, this flap was salvaged by resection of the compromised superficial venous system and the use of an interposition vein graft as no other suitable recipient vein was available.
This case may serve as a reminder to explore early and be aware that the crux of a complication may be at a distance from the operative field. Consideration must be given to the possible need for interposition vein grafts when a suitable local deep or superficial recipient vein is not available in the lower limb.
重建外科医生都知道深静脉血栓形成可导致游离皮瓣失败；然而，文献中尚无关于存在浅静脉血栓形成时游离皮瓣失败发生率的报道。
一名38岁的白人男性患者，I型糖尿病控制不佳，右胫骨远端骨髓炎上方有一个慢性感染性溃疡。该区域采用背阔肌肌皮游离皮瓣进行重建。
在距背阔肌肌皮游离皮瓣静脉吻合口21厘米处发现浅静脉血栓形成，导致静脉充血。早期探查后，由于没有其他合适的受区静脉，通过切除受损的浅静脉系统并使用一段移植静脉，挽救了该皮瓣。
该病例可提醒人们要尽早进行探查，并意识到并发症的关键可能距离手术区域较远。当下肢没有合适的局部深静脉或浅静脉作为受区静脉时，必须考虑可能需要使用移植静脉。
