小隐静脉三种处理方案对下肢远端皮肤软组织缺损合并骨关节外露患者皮瓣存活的影响(1)
[摘要]目的：比較三种不同小隐静脉处理方案对下肢远端皮肤软组织缺损合并骨关节外露患者皮瓣存活情况的影响。方法：选取2008年1月-2017年1月笔者医院烧伤外科收治的180例因电击伤或热挤压伤手术扩创后出现下肢远端皮肤软组织缺损合并骨关节外露患者，按照对小隐静脉处理方式的不同分为对照组，结扎组及吻合组，每组60例。所有患者均采用腓肠神经营养血管皮瓣进行修复皮肤缺损。对照组于皮瓣近端将腓肠神经及小隐静脉离断并结扎；结扎组在对照组基础上于皮瓣蒂的小隐静脉起始处结扎；吻合组将小隐静脉与受区相应静脉进行吻合。观察三组患者手术前后IL-6、TNF、LPS等炎症指标变化情况，比较三组患者术后皮瓣坏死发生率和皮瓣肿胀及青紫发生情况。结果：三组患者术后14d IL-6、TNF、LPS炎症因子水平较术前均有所改善，且结扎组与吻合组术后14d IL-6、TNF、LPS炎症因子水平均低于对照组，差异有统计学意义(P<0.05)；吻合组与结扎组比较，差异无统计学意义(P>0.05)。结扎组与吻合组术后皮瓣肿胀及青紫发生率、皮瓣肿胀及青紫持续时间、皮瓣坏死率均优于对照组，差异有统计学意义(P<0.05)；吻合组与结扎组比较，差异无统计学意义(P>0.05)。结论：对于电击伤或热挤压伤所致下肢远端皮肤缺损伴骨关节外露患者，术中通过结扎小隐静脉起始处或将小隐静脉与受区静脉网吻合能够取得较为满意的临床疗效，提高皮瓣存活率。
, http://www.100md.com
[关键词]小隐静脉；电击伤或热挤压伤；皮肤缺损；骨关节；皮瓣
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)07-0036-03
Abstract： Objective To compare the effects of three different small saphenous vein treatments on patients with distal skin and soft tissue combined with exsertion of bone and joint caused by an electric or hot crush wound. Methods From January 2008 to January 2017，180 cases in our hospital with skin and soft tissue defect of distal lower extremity with exsertion of bone and joint caused by an electric or hot crush wound were divided into the control group，the ligation group and the anastomosis group，60 cases in each group. All patients were treated with gastrocnemius vascular flap to repair the skin defect.In the control group， the sural nerve and the small saphenous vein were severed and ligated at the proximal end of the flap.The ligation group was ligated at the beginning of the small saphenous vein pedicled with the flap on the basis of the patients in the control group.In the anastomosis group， the small saphenous vein was anastomosed with the corresponding vein in the recipient area.The inflammatory indexes such as IL-6， TNF， LPS were observed before and after the operation of three groups of patients. The swelling of skin flaps and the occurrence of blue-violet and skin flap necrosis were observed. Results The levels of inflammatory factors IL-6， TNF and LPS were improved after operation in the three groups， and the levels of IL-6， TNF and LPS in the ligation group and the anastomosis group were lower than those in the control group， the differences were statistically significant(P<0.05). There was no significant difference between the anastomosis group and the ligation group(P>0.05). The flap swelling and cyanosis incidence， flap swelling and cyanosis duration， skin flap necrosis rate in the ligation group and the anastomosis group were better than those in the control group(P<0.05). There was no significant difference between the anastomosis group and the ligation group(P>0.05). Conclusion For patients with distal skin defect of lower extremity caused by electric shock injury or hot crush injury with exsertion of bone and joint， ligating the small saphenous vein at the beginning or anastomosis of the small saphenous vein with the recipient venous network during the surgery can obtain satisfactory clinical results，increase the survival rate of skin flap., 百拇医药(陈志军 王超文)
, http://www.100md.com
[关键词]小隐静脉；电击伤或热挤压伤；皮肤缺损；骨关节；皮瓣
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)07-0036-03
Abstract： Objective To compare the effects of three different small saphenous vein treatments on patients with distal skin and soft tissue combined with exsertion of bone and joint caused by an electric or hot crush wound. Methods From January 2008 to January 2017，180 cases in our hospital with skin and soft tissue defect of distal lower extremity with exsertion of bone and joint caused by an electric or hot crush wound were divided into the control group，the ligation group and the anastomosis group，60 cases in each group. All patients were treated with gastrocnemius vascular flap to repair the skin defect.In the control group， the sural nerve and the small saphenous vein were severed and ligated at the proximal end of the flap.The ligation group was ligated at the beginning of the small saphenous vein pedicled with the flap on the basis of the patients in the control group.In the anastomosis group， the small saphenous vein was anastomosed with the corresponding vein in the recipient area.The inflammatory indexes such as IL-6， TNF， LPS were observed before and after the operation of three groups of patients. The swelling of skin flaps and the occurrence of blue-violet and skin flap necrosis were observed. Results The levels of inflammatory factors IL-6， TNF and LPS were improved after operation in the three groups， and the levels of IL-6， TNF and LPS in the ligation group and the anastomosis group were lower than those in the control group， the differences were statistically significant(P<0.05). There was no significant difference between the anastomosis group and the ligation group(P>0.05). The flap swelling and cyanosis incidence， flap swelling and cyanosis duration， skin flap necrosis rate in the ligation group and the anastomosis group were better than those in the control group(P<0.05). There was no significant difference between the anastomosis group and the ligation group(P>0.05). Conclusion For patients with distal skin defect of lower extremity caused by electric shock injury or hot crush injury with exsertion of bone and joint， ligating the small saphenous vein at the beginning or anastomosis of the small saphenous vein with the recipient venous network during the surgery can obtain satisfactory clinical results，increase the survival rate of skin flap., 百拇医药(陈志军 王超文)