Large Arteriovenous Flow-Through Venous Flap with Complete Flap Survival-A Case Report

大型動靜脈直流性游離靜脈皮瓣―完全存活之病例報告

陳炳光(Bing-Guang Chen) ； 楊菘宇(So-Yu Young) ； 曾繁穎(Feng-Yin Tseng) ； 林煌基(Hwang-Chi Lin) ； 蔡裕銓(Yuh-Chyuang Tsai)

《中華民國重建整形外科醫學會雜誌》 8卷1期 (1999/03) Pp. 62-67

https://doi.org/10.7096/JPRSA.199903.0062

摘要

游離靜脈皮瓣在重建手術上的運用可以增加選擇性，特別是當病患需要縮短手術時間或者要減低捐贈部位的功能性缺損。對手術醫師而言，此類皮瓣的選擇也能夠減少手術的複雜性。游離靜脈皮瓣主要是靠血管吻合術來供給皮瓣組織的血液循環。其缺點是此類皮瓣常因充血而有發生部份性壞死的可能。本報告提出一個因為麻醉時間因素之考量而選用大形游離靜脈皮瓣做直流式動脈至靜脈的吻合(Large arteriovenous flow-through venous flap)，並且洩液端只做一個靜脈至靜脈之吻合而完全存活的特例，其大小為長20公分，寬7.5公分。本例皮瓣成功的因素可能包括皮瓣本身的細微血管組織完整、術前的皮瓣設計、手術的技術與速度之掌握、以及原先傷口的清創與良好底部循環等。此例對於游離靜脈皮瓣大小之研究提供一個臨床上的經驗，希望對未來的研究者有所助益並激發更多的討論。

並列摘要

Venous free flaps used for coverage of defects in reconstructive surgery provide the primary advantages of technical efficiency and less donor site morbidity compared to myocutaneous flaps. The blood supply of such flaps is derived mainly from anastomosis of the vein of the flap to the vessels of the recipient site. Unfortunately, the success rate in this type of flap remains uncertain due to flap congestion and sometimes partial or total flap necrosis. A case report is presented here showing the complete survival of a large arteriovenous flow-through venous flap (sized 20×7.5 cm^2) despite anastomosis of only one flow-through vessel. In this case the saphenous vein is anastomosed to the recipient artery distally and vein proximally. The possible factors contributing to the success of this flap transfer is discussed, and hopefully this will invoke more discussions in the future on this type of A-V flow-through flap transfers.

並列關鍵字

arteriovenous flow-through venous flap