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一、临床资料与分析例1 女性,52岁,病案号01345,因左舌侧绿鳞状细胞癌入院。在全麻下行舌癌联合根治,左前臀游离皮瓣移植舌修复术。术后2小时,皮瓣前中1/3交界处外缘皮下出现三处0.5—1.0cm瘀斑,呈暗紫色,毛细血管反映良好。分析:1皮瓣下血肿压迫静脉回流不畅所致。 2、皮瓣与相对牙齿接触压迫所致。例2 男性,42岁,病案号01409,因右颊粘膜鳞状细胞癌入院。在全麻下行右颊癌切除、右颈清、左前臂游离皮瓣移植术。术后皮瓣血运良好,颜色正常。术后第三天晨,病人自行去厕所排便,步行回苏醒室。上床即刻发现皮瓣前下缘出现点状瘀血,继而扩展为瘀斑,范围为2×2cm;毛细血管反应差。分析:颈部制动所致的皮瓣供血血管的扭曲,牵拉形成静脉血栓。二、讨论 1、严密观测皮瓣颜色及温度变化。术后72小时,带血管游离皮瓣最易发生危象。
First, the clinical data and analysis of cases 1 female, 52 years old, case number 01345, due to left lingual squamous cell carcinoma admission. Tongue cancer under general anesthesia combined radical mastectomy, left anterior buttock free flap transplantation tongue repair. Two hours after operation, three 0.5-1.0 cm ecchymosis appeared subcutaneously at the outer edge of the middle 1/3 of the skin flap, showing a dark purple color with a good capillary reflection. Analysis: 1 subcutaneous hematoma oppression caused by poor venous return. 2, caused by contact with the flap and the relative teeth. Example 2 Male, 42 years old, case number 01409, admitted to the right buccal mucosa squamous cell carcinoma. Under general anesthesia right cheek cancer resection, right neck, left forearm free flap transplantation. Postoperative flap blood flow well, the color is normal. On the third day after surgery, the patient went to the toilet defecation on their own and walked back to the awakening room. Immediately before going to bed was found in the lower edge of the flap appeared punctate bleeding, then extended to ecchymosis, the scope of 2 × 2cm; poor capillary reaction. Analysis: Neck brake caused by blood vessels distorting the flap, pull the formation of venous thrombosis. Second, the discussion 1, close observation of flap color and temperature changes. 72 hours after surgery, the most prone to crisis with vascular free flap.