总结四肢血管损伤诊治经验,进一步提高治疗效果。方法:收集我院2009年2月~2012年9月救治的66例四肢血管损伤患者,所有患者均采用显微外科技术进行修复。结果:本组66例患者损伤血管133条,单纯修补术8条,端端吻合109条,自体大隐静脉移植16条,1例因伤口感染尺动脉破裂而结扎,损伤动脉复通率98.48%;合并骨折者26例,1例因骨外露截肢,其余经过治疗感觉及运动功能无障碍。结论:肢体大血管损伤,采用显微外科技术可提高治愈率。

O bjective:To summarize the experience of diagnosis and treatment of vascular injury in limbs , improving the treatment effect.Methods:Collected 66 cases of vascular injury in limbs patients being treated in our hospital from February 2009 to Septem-ber2012, all patients were treated by microsurgical technique to repair .Results:In this group of 66 cases,total 133 vascular injuries, there were 8 simple repairs, 109 end to end anastomosis , 16 autologous greater saphenous vein transplantation , 1 case ligation because of wound infection and injury of ulnar artery rupture .Artery recanalization rate was 98.48%;26 cases were combined with fracture , 1 case of am-putation due to bone exposure , the rest didnot encounter sensory and motor function barrier after treatment .Conclusion:For great vessels injury in limbs, using microsurgery technique can improve the cure rate .

目的探讨负压封闭引流技术（vacuum sealing drainage，VSD）在血管损伤患者接受血管吻合后创面应用的治疗效果。方法2011年1月至2013年10月，我院治疗的61例四肢血管损伤患者，通过直接吻合或血管移植进行治疗，其中33例血管吻合口周围创面无法一期关闭，以周围组织覆盖血管吻合口后将VSD应用于血管吻合口周围创面及远端减张创面，而另外28例血管吻合口创面可直接关闭，远端减张创面应用VSD覆盖。结果本组61例中，6例因各种原因而保肢失败，最终截肢治疗，其余55例创面通过游离植皮或者皮瓣而得到关闭，在应用VSD治疗过程中未出现严重不良事件。结论负压封闭引流技术在血管损伤患者中应用可获得良好治疗效果，对血管吻合口以周围组织覆盖后应用持续负压吸引未引发吻合口痉挛或者堵塞。

Objective To investigate the effects of vacuum sealing drainage ( VSD ) technique to repair the wounds of the patients with vascular injuries in extremities who were treated with vascular anastomosis. Methods From January 2011 to October 2013, 61 patients with vascular injuries in extremities were treated in our hospital, all of whom underwent direct vascular anastomosis or vascular graft. The wounds around vascular anastomosis could not be closed by ifrst intention in 33 patients. Vascular anastomosis was covered by surrounding tissues and the VSD technique was used in the wounds around vascular anastomosis and in the distal wounds of decompression. In the other 28 patients the wounds around vascular anastomosis were closed directly, and the VSD technique was used in the distal wounds of decompression. Results Limb salvage treatment failed in 6 cases due to various reasons, and amputation was performed ifnally. The wounds in the other 55 cases were closed by free skin graft or the lfa

随着工业和交通的发展,四肢软组织缺损是临床常见损伤类型,易导致肌腱、血管及骨外露,临床处理较棘手.穿支皮瓣是一种新的外科技术,由Koshima等[1]和Kroll等[2]首先报道.由于该种皮瓣以穿支血管为蒂,不牺牲知名主要血管,减少对供区的损伤,日渐受到重视[3-5].近年来,我们对腓动脉穿支为蒂的皮瓣血供进行深入研究的基础上,于2011年10月至2012年7月,将腓动脉穿支皮瓣游离移植用于修复手足部软组织缺损,疗效满意,现介绍如下.

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目的 探讨“T”形血管吻合的游离腓动脉穿支皮瓣移植修复四肢创面缺损的方法及临床效果.方法 自2009年3月至2012年5月,对9例四肢创面缺损的患者采用游离腓动脉皮瓣以“T”形血管吻合的方式移植修复,包括创伤导致皮肤、软组织缺损5例,合并有肢体主干血管损伤3例,糖尿病溃疡创面2例,足背肿物切除后感染导致皮肤坏死缺损1例,手背烧伤瘢痕1例.术后行显微外科常规治疗. 结果 2例术后发生静脉危象,经手术探查切除栓塞的静脉吻合口并予以重新吻合,9例皮瓣最终存活良好,皮瓣质地良好,外形美观,伤口均一期愈合,术后1个月经超声多普勒检查证实桥接血管血流均通畅(9/9,100％).7例获得有效随访12个月,患者对皮瓣外形满意度高(7/7,100％),术后6个月皮瓣恢复两点辨别觉,术后12个月平均值为(9.9 ±2.1)mm,皮瓣感觉评级为S3+级,AOFAS评分平均值为87.2,优3例,良4例. 结论 “T”形血管吻合的腓动脉穿支皮瓣移植可以较好的修复创面,同时能重建或避免破坏肢体远端血运,对于合并主干血管损伤的创面以及肢体远端血运不良导致的慢性缺血性创面的修复具有良好的适应证和应用价值.

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目的：探讨负压封闭引流（ VSD）技术应用于软组织损伤创面早期修复的疗效；方法：对68例四肢软组织损伤患者将撕脱、离体及弃用肢体皮肤修剪成网状全厚皮片或含真皮下血管网皮瓣回植覆盖皮肤缺损创面，采用负压封闭引流技术促进创面肉芽组织及皮片生长修复创面。结果：68例愈合时间15~28 d，术后创面Ⅰ期愈合率为82.4%，Ⅱ期愈合率为100%；经3~24个月随访，患者皮肤弹性、感觉恢复满意。结论：该技术有效促进创面肉芽组织及皮片生长，缩小Ⅱ期植皮或皮瓣转移修复创面，是一种操作简便、疗效确切的治疗方法。

Objective To investigate the effect of vacuun sealing drainage( VSD)technique was applied to the soft tissue injury of ear-ly wound repair. Method 68 patients with injury of soft tissue avulsion,isolated and abandoned the linb skin cut into a nesh of full thick-ness skin graft or flap with subdernal vascular network skin defect of planting back cover,VSD technology was applied to pronote granula-tion tissue growth and skin wound repair. Results 68 cases healed in 15 ~ 28 d,postoperative wound healing rate was 82. 4%,in stage II healing rate was 100%;after 3~24 nonths follow-up,patients with skin elasticity,sensory recovery satisfaction. Conclusion This tech-nique is effective to pronote the growth of granulation tissue and skin,can reduce secondary skin grafting or flap to repair the wound,is a sinple,effective nethod.