Park Su Han, Choi Woo Young, Son Kyung Min, Cheon Ji Seon, Yang Jeong Yeol
Department of Plastic and Reconstructive Surgery, Chosun University School of Medicine, Gwangju, Korea.
Arch Craniofac Surg. 2015 Dec;16(3):143-146. doi: 10.7181/acfs.2015.16.3.143. Epub 2015 Dec 9.
In this report, we present a scalp defect reconstruction with lateral arm free flap. We highlight the difficulty in obtaining a recipient vein and the venous drainage managed through an open end of the donor vein. A 52-year-old woman presented with a pressure sore on the left scalp. A lateral arm free flap was transferred to cover this 8×6 cm defect. The arterial anastomosis was successful, but no recipient vein could be identified within the wound bed. Instead, we used a donor venous end for the direct open venous drainage. In order to keep this exposed venous end patent, we applied heparin-soaked gauze dressing to the wound. Also, the vein end was mechanically dilated and irrigated with heparin solution at two hour intervals. Along with fluid management and blood transfusion, this management was continued for the five days after the operation. The flap survived well without any complication. Through this case, we were able to demonstrate that venous congestion can be avoided by drainage of the venous blood through an open vessel without the use of leeches.
在本报告中，我们介绍了一例采用上臂外侧游离皮瓣修复头皮缺损的病例。我们强调了获取受区静脉的困难以及通过供体静脉开放端进行静脉引流的处理方法。一名52岁女性因左侧头皮压疮就诊。采用上臂外侧游离皮瓣转移修复这个8×6厘米的缺损。动脉吻合成功，但在创面内未找到合适的受区静脉。于是，我们使用供体静脉的开放端进行直接开放静脉引流。为保持这个暴露的静脉端通畅，我们在伤口上应用了浸有肝素的纱布敷料。此外，每隔两小时对静脉端进行机械扩张并用肝素溶液冲洗。术后五天，在进行液体管理和输血的同时持续进行上述处理。皮瓣顺利存活，未出现任何并发症。通过这个病例，我们证明了无需使用水蛭，通过开放血管引流静脉血可避免静脉淤血。
