腓骨游离皮皮瓣腓骨静脉深静脉血栓形成一例

S. Hayashi, K. Kawamura, Naoki Maegawa, Akito Nakanishi, Yasushi Mizutani, Akinori Okuda, Shinpei Kurata, Takamasa Shimizu, T. Kira, S. Omokawa, Yasuhito Tanaka
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引用次数: 1

摘要

背景下肢深静脉血栓形成(DVT)是一个广泛存在的医学问题,与高凝状态有关。虽然腓骨皮瓣腓骨静脉自发血栓形成在理论上是可能的,但在腓骨皮瓣切除过程中,腓骨静脉无症状血栓形成的病例很少报道。病例报告一名45岁男性因跌倒导致胫骨节段性骨缺损。计划采用对侧小腿带血管的游离腓骨皮皮瓣进行治疗。术中腓骨静脉系统发现弥漫性血栓。去除血栓后,腓骨与腓骨血管与受体胫后血管吻合,进行腓骨移植。皮瓣的皮肤桨叶术后充血;用多个皮肤切口对皮肤进行放血以缓解充血。尽管进行了治疗,但皮肤桨叶部分坏死,并进行了额外的皮肤移植。移植腓骨在初次手术后5个月实现骨愈合。结论据我们所知,仅报道了6例游离腓骨皮瓣腓骨静脉内原有深静脉血栓的病例。其中3例腓骨瓣移植成功。尽管腓骨静脉血栓形成的患者可以成功进行游离骨皮腓骨皮瓣手术,但对于高危患者,建议进行仔细的术前评估。
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A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap
Abstract Background Deep venous thrombosis (DVT) of the lower leg is a widespread medical problem and is associated with hypercoagulable states. Although spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible, few cases of asymptomatic DVT of the peroneal vein encountered during fibula flap harvest have been reported. Case Report A 45-year-old man presented with segmental bone defects of the tibia resulting from a fall. Treatment with a free vascularized osteocutaneous fibula flap from the contralateral lower leg was scheduled. Intraoperatively, diffuse thrombi were found in the peroneal venous system. After removal of thrombi, the fibula was grafted with anastomosis of the peroneal vessels to the recipient posterior tibial vessels. The skin paddle of the flap became congested after surgery; exsanguination of the skin paddle was performed with multiple skin incisions to relieve congestion. Despite treatment, the skin paddle became partially necrotic and additional skin grafting was performed. Bone union of the grafted fibula was achieved 5 months after initial surgery. Conclusions To the best of our knowledge, only six cases of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap have been reported. In three of these cases, the fibula flap was successfully grafted. Although successful free osteocutaneous fibula flap surgery might be possible in patients with peroneal venous thrombosis, careful preoperative evaluation is recommended for high-risk patients.
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