Free Flap Failures in a Patient with Primary Antiphospholipid Syndrome

一位22歲年輕漁夫，因左下肢意外撕裂傷後，歷經縫合傷口未癒，再經植皮仍反覆下肢潰瘍，影響捕魚工作。因此要求重建穩當的軟組織克服其難。此健壯男性，不抽煙，不喝酒，無藥癮，一般心電圖，血液生化檢查正常，因此施行闊背肌肉瓣顯微游離手術，過程順利。但手術一天後，皮瓣漸行壞死，未被及早注意，喪失探查搶救機會。一周後再以另一側闊背肌肉瓣顯微游離手術，過程仍順利，術後以體表溫度計每小時密切監測，仍在術後一天，發現皮瓣有靜脈血循環栓塞呈壞死傾向，經緊急探查、血栓移除及肝抗凝素(Heparin)溶血急救，血循環獲得改善，但一天後仍出現相同血栓現象。雖再次緊急探查重建，最後皮辮仍壞死以致重建失敗。終在一連串探討檢查中發現，患者為「原發性抗磷酯症候群」。此症候群以血栓形成於動靜脈為其主要臨床症候，較常在內科或婦產科醫誌出現，鮮少於外科醫誌討論。抗磷酯症候群的確會造成血管栓塞，但文獻統計認為抗磷酯抗體濃度與手術後致血管栓塞有關。抗體濃度越高，就有較高栓塞可能性，需列入鑑別診斷。但因此症候群出現機會不高，除非有臨床症兆，否則於手術前，並無例行抽血檢查抗體濃度之必要。

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並列摘要

This article presents a young fisherman with no history of smoking, drug abuse, or alcoholism who was found with a large intractable ulcer over his left leg. Previous surgical treatment of the wound resulted in two failures including a failed primary repair and a failed skin graft. Two separate latissimus dorsi free flaps were attempted, and each time the flap failed to survive. The second free flap transfer was carefully monitored postoperatively. Emergency reexploration and heparinization were attempted upon identification of vessel thrombosis without success. Errors of surgical technique and external compression or kinking of the pedicle were excluded. The cause of flap pedicle thrombosis was studied retrospectively, and it was found that the patient suffered from a primary antiphospholipid syndrome. Previous discussions on antiphospholipid syndrome found in medical and obstetrical journals correlate the condition with a high risk of vascular thrombosis. At present, however, there are no reports of primary antiphospholipid syndrome associated with free flap failures. This case report demonstrates an instance where a high titer of antiphospholipid antibody correlated with increased risk of postoperative vessel thrombosis.

並列關鍵字

antiphospholipid syndrome ； free flap transfer

國際替代計量

Free Flap Failures in a Patient with Primary Antiphospholipid Syndrome

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