BACKGROUND: Local thrombosis of vascular anastomosis is still the main reason of failure and necrosis of free flap grafting.rnOBJECTIVE: To assess the clinical application value of vein intubatton in monitoring and preventing vascular crisis after free flap grafting.rnMETHODS: 102 cases of tongue, gena and mandible carcinomas tissue defects were reconstructed by free radical forearm flaps, fibular osteocutaneous flap and iliac osteomusculocutaneous flap were divided into two groups. The patients in the experimental group (n=50) were treated with vein intubatton from distal vein of free flap by which dilute heparin saline were given as needed, intravenous drip dextran-40 were given, average 20 mL/h and lasted for 7 days. The patients in the control group (n=52) were treated with intravenous drip dextran-40 of 500 mL once a day.rnRESULTS AND CONCLUSION: A total of 50 flaps in the experimental group were all survived without occurring vascular crisis, while three flaps in the control group had venous crisis, two of them were not successfully salvaged. It shows that the application of vein intubatton in free flap graft can monitor blood supply of free flap continuously, prevent venous thrombosis effectively and improve flap survival.%背景:血管吻合口局部血栓形成仍是导致游离组织瓣移植失败和坏死的主要原因.目的:评价静脉留置管在游离组织瓣移植监测与预防血管危象中的临床应用价值.方法:应用前臂皮瓣、腓骨肌(皮)瓣、髂骨肌骨瓣等游离移植修复舌、颊、下颌等部位组织缺损患者102例.实验组(n=50)组织瓣静脉远心端留置静脉管,术中根据需要灌注稀释肝素生理盐水,术后通过静脉留置管输注低分子右旋糖酐,20 mL/h,持续7 d.对照组(n=52)术后全身给予低分子右旋糖酐500 mL静脉滴注,1次/d.结果与结论:实验组50例组织瓣全部存活,未出现血管危象;对照组52例中有3例出现静脉危象,其中2例抢救无效组织瓣坏死.提示静脉留置管能持续监测游离组织瓣移植后组织瓣血管通畅状况,有效预防血管危象,提高组织瓣的成活率.
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