Department of Orthopaedic Surgery, Division of Hand Surgery, University of California, Irvine, Orange, CA, USA.
J Reconstr Microsurg. 2011 May;27(4):243-50. doi: 10.1055/s-0031-1275488. Epub 2011 Mar 24.
This report describes the creation of a venocutaneous fistula to salvage a free fibular osteocutaneous flap compromised by extensive venous thrombosis. This technique has previously been described for salvage of digital replants, but this is the first report of a venocutaneous fistula being used to salvage a free flap. A 21-year-old woman underwent a 9-cm resection of the distal left tibia for an aneurysmal bone cyst. A contralateral right fibular osteocutaneous free flap was used for reconstruction. On postoperative day 2, the skin paddle showed evidence of venous congestion. Reexploration demonstrated extensive thrombosis throughout the entire venous system of the flap. The venae comitantes were transected as far back as possible and brought to the surface of the skin through two small stab wounds to allow venous egress. After a short course of heparin and dextran, the skin flap healed uneventfully and both osteosynthesis sites consolidated. A venocutaneous fistula provides a path of relatively low resistance for venous outflow, improving the arterial inflow-venous outflow balance for a short time until neovascularization and collateral venous channels develop. The venocutaneous fistula technique may be considered for salvage of free flaps compromised by extensive venous thrombosis.
本报告介绍了一种通过建立动静脉瘘来挽救因广泛静脉血栓形成而受损的游离腓骨皮瓣的方法。这种技术以前曾被用于挽救再植的手指，但这是首例报告使用动静脉瘘来挽救游离皮瓣的案例。一名 21 岁女性因动脉瘤样骨囊肿而行左胫骨远端 9cm 切除术。使用对侧右侧腓骨皮瓣进行重建。术后第 2 天，皮瓣出现静脉淤血的迹象。再次探查显示整个皮瓣的静脉系统均有广泛血栓形成。尽可能地切断伴行静脉，并通过两个小的戳口将其带到皮肤表面，以允许静脉流出。在短期使用肝素和右旋糖酐后，皮瓣愈合良好，两个骨固定部位均愈合。动静脉瘘为静脉流出提供了一条相对低阻力的路径，在新血管形成和侧支静脉通道建立之前，短时间内改善了动脉流入-静脉流出的平衡。对于因广泛静脉血栓形成而受损的游离皮瓣，可考虑采用动静脉瘘技术进行挽救。
