How to Confirm the Reliability of a Recipient Artery in Free Tissue Transfer to the Distal Leg and Foot

適當的選擇接受區血管是為轉移自由皮辮以重建下肢組織缺損成功與否的關鍵。為避免因為未發現接受區動脈的損傷而在有問題的地方做血管吻合，在執行顯微重建循環之前要很小心的評估接受區動脈的情況。然而，由於文獻上沒有明確描述衡量標準，要判斷接受區動脈是否可靠是有困難的。本篇報告提出一個簡單而有效的接受區動脈衡量方法“重複動態噴血檢測法”。我們的研究就是針對這種動脈檢測法，分析其是否有助於選擇一條安全可靠的接受區動脈來完成遠端小腿以及足部的顯微手術重建。這篇報告包含230個皮辮重建手術，其中有21個需要緊急再探查血管。分析其原因，發現有8個是動脈發生阻塞（動脈阻塞發生率為8/21, 38%）。這當中，有四塊皮辦是選擇腔前動脈當接受區動脈（占50%），三塊是選擇脛後動脈。在全部皮辮中有112塊是選擇脛前動脈為接受區動脈，其需要再探查血管的比率是8/112(7.1%)，這與選用脛後動脈當接受區動脈而需要再探查血管的比率(9/95, 9.5%)比較起來，已經不再有太多差異。經由“重複動態噴血檢測法”仔細的評估選擇後，腔前動脈不再是較不可靠的接受區動脈了。此外，特別對急性外傷的病患作研究，我們也發現因為動脈阻塞等問題而需要再打開搶救的比率同樣明顯降低了(4.6%)。 “重複動態噴血檢測法”能有效的降低動脈併發症以及皮辦移植失敗的發生率。使用這個檢測法，要選擇一條安全的接受區動脈來達成皮瓣的循環重建已不再困難。

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並列摘要

The selection of an appropriate recipient vessel is essential for the success of free tissue transfer to the lower leg. To disclose unnoticed damage of the proposed recipient artery and to avoid conducting anas- tomosis in the unhealthy vessel segment, we must carefully verify the vascular integrity prior to the microsurgical revascularization. For that purpose, a simple and effective evaluation method, called ”double spurting test (DST)”, is proposed in this paper. This study analyzes if this examination could be an useful tool in searching a safe recipient artery during microsurgical reconstruction for distal leg and foot. In this series of 230 flaps, re-exploration was done in 21 cases. Arterial problems occurred in 8 cases (arterial problem rate 8/21, 38%). Four of these 8 cases had anterior tibial artery (ATA) as the recipient artery (50%), 3 had posterior tibial artery (PTA). In 112 ATA has been selected as recipient artery and the re-open rate of these cases was 7.1% (8/112). The re-open rate had no much difference with those selecting PTA as recipient artery (9/95, 9.5%). Anterior tibial artery has not to be considered less reliable, as recipient artery, than PTA after close examination with DST. Especially in acute trauma cases, significant decrease of arterial associated re-open rate was observed (4.6%). ”Double spurting test” can effectively decrease the incidence of arterial complications and flap failure. Using this method, it is not difficult to choose a safe recipient artery for revasculization.

並列關鍵字

recipient artery ； double spurting test ； arterial complications ； revasculization ； free tissue transfer

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How to Confirm the Reliability of a Recipient Artery in Free Tissue Transfer to the Distal Leg and Foot

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