游離皮瓣重建手術後之罕見遲發性併發症－偽動脈瘤病例報告

游離皮瓣手術是現今頭頸部缺損最主要的重建方式。但由於牽涉到血管吻合手術，相較來說較為複雜。有時因為栓塞等血管相闋的併發症，導致皮瓣壞死，而這些併發症通常在重建之後48小時內發生。一般來說，吻合之血管及皮瓣在七到十四天之後漸趨穩定。本報告提出一罕見的遲發性併發症病例。術後一個月發現血管吻合處發生偽動脈瘤，伴隨白發性出血現象。在手術止血未發現出血點之情況下，以血管攝影診斷出偽動脈瘤並以經血管栓塞治療，成功止血且保存皮瓣之活性。因發生於頭頸部重建血管吻合後之偽動脈瘤並不常見，且順利以血管攝影及血管栓塞術治療成功，故提出病例報告並進行文獻回顧。

關鍵字

偽動脈瘤；血管吻合；經動脈栓塞術

並列摘要

Free flap surgery is the mainstay of head and neck reconstruction today. Its complexity comes from vessel anastomosis, as well as complications like thrombosis and vessel spasm. Such complications usually happen within 48 hours after vessel anastomosis surgery and would cause flap failure or necrosis. Generally, the reconstructed flaps and anastomosed vessels become stable seven to fourteen days postoperatively. In this article, we reported a case of late complication, which happened one month postoperatively. A 57 year old male patient had history of hypertension and diabetes mellitus under medical control, received tongue cancer excision surgery and reconstructed with anterolateral thigh fasciocutaneous free flap, complained about spontaneous intermittent intraoral bleeding. Due to exploratory surgery did not find the bleeding point, angiography was performed for diagnosis. A pseudoaneurysm over vessel pedicle anastomosis site was found and treated with tanscatheter arterial embolization (TAE). After embolization, spontaneous bleeding was treated successfully and the flap was preserved. Due to its rarity, we reported this case and reviewed related literatures, try to found out the etiology and treatment modalities.

並列關鍵字

Pseudoaneurysm ； Vessel anastomosis ； Tanscatheter arterial embolization

國際替代計量

游離皮瓣重建手術後之罕見遲發性併發症－偽動脈瘤病例報告

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