游离皮瓣移植乳房再造手术并发血管危象的原因 以及分类和分期特点探讨.

Objective To explore and summarize the causes, classification and staging of vascular crisis in free flap transfer breast reconstruction. Methods From June 2015 to June 2021, a total of 605 cases of free flap transfer breast reconstruction were included in this group, including 412 cases of primary breast reconstruction and 193 cases of delayed breast reconstruction, the flap form included 547 cases of free lower abdominal flap and 58 cases of free posterior medial thigh flap. The occurrence of vascular crisis was counted, and the specific causes, classification and staging characteristics of vascular crisis were further summarized. According to the changes of skin flap color, the difference between flap surface temperature and normal skin temperature, and the changes of monitoring data of audible Doppler, the stages of progressive arterial crisis include: hidden stage, arterial blood supply disorder stage, venous reflux obstruction stage, thrombosis stage and flap necrosis stage. The stages of progressive venous crisis include: hidden stage, venous reflux obstruction stage, venous embolism stage, arterial blood supply disorder stage, thrombosis stage and flap necrosis stage. Results Vascular crisis occurred in 65 cases of this group, including 16 cases of acute arterial vascular crisis and 25 cases of acute venous vascular crisis, all of which were treated in time and rescued successfully during the operation. There were 10 cases of progressive arterial vascular crisis, of which 2 cases were treated in time and successfully rescued. Total flap failure occurred in the other 8 cases, in 5 cases the wound was closed directly, in other 3 cases free posterior medial thigh flap was transferred for salvage. In 14 cases of progressive venous vascular crisis, the flaps in 5 cases received successfully salvage, and the flaps in the other 9 cases totally failed. In 7 cases the wound was closed directly, in other 2 cases free posterior medial thigh flap was transferred for salvage. Conclusion In breast reconstruction with free flap transplantation, classification and staging of vascular crisis of flap is helpful to discriminate the cause and progress of vascular crisis, and to predict the significance and success rate of reexploration, the risk of flap necrosis and the postoperative effect. [ABSTRACT FROM AUTHOR]