Ao Masakazu, Nakago Kie, Morisada Sunao, Koshimune Seijirou
Department of Plastic and Reconstructive Surgery, Iwakuni Clinical Center, National Hospital Organization, Iwakuni, Yamaguchi, Japan.
Ann Plast Surg. 2012 Jul;69(1):45-7. doi: 10.1097/SAP.0b013e3182212851.
In some cases of degloving injury, as a result of multiple venous anastomoses formed on the peripheral and proximal sides, the detached flap skin did survive, though with patchy necrosis. On the basis of this experience, the skin and soft-tissue defects after removing skin cancer were closed with an anterolateral thigh true perforator flap, measuring 4 × 5 cm in size, which is nourished by venous blood. The subcutaneous vein on the peripheral side of the defect was anastomosed to the perforator artery, and the veins on the proximal side of the defects were anastomosed to the concomitant veins of the perforator. After surgery, to ensure a sufficient blood flow to the flap, the affected limb was positioned lower than the heart for 1 week. To prevent microthrombus in the perforator branch and the flap, preventive anticoagulant therapy was performed. The transplanted flap had marked cyanosis for a few days, but turned pinkish on the sixth day after surgery. The flap survived completely. As opposed to venous flaps reported in the past, the physiologic direction of blood flow of the flap is from arteries to veins, and it is nourished exclusively by venous blood. If a flap is small, and there are no appropriate recipient vessels nearby, this method could serve as a favorable alternative.
在某些脱套伤病例中，由于在周边和近端形成了多个静脉吻合，分离的皮瓣皮肤尽管有片状坏死，但确实存活了下来。基于这一经验，采用大小为4×5厘米的股前外侧真皮下血管穿支皮瓣修复皮肤癌切除术后的皮肤和软组织缺损，该皮瓣由静脉血供血。缺损周边的皮下静脉与穿支动脉吻合，缺损近端的静脉与穿支的伴行静脉吻合。术后，为确保皮瓣有足够的血流，将患肢置于低于心脏的位置1周。为防止穿支分支和皮瓣内形成微血栓，进行了预防性抗凝治疗。移植的皮瓣最初几天有明显的青紫，但术后第六天转为淡红色。皮瓣完全存活。与过去报道的静脉皮瓣不同，该皮瓣的生理性血流方向是从动脉到静脉，且仅由静脉血供血。如果皮瓣较小，且附近没有合适的受区血管，这种方法可作为一种不错的选择。
