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題名 | Anterolateral Thigh Flap for Lower Extremity Reconstruction under Epidural Anesthesia=硬膜外麻醉下使用前外側股皮瓣於下肢重建 |
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作者 | 黃介琦; 戴浩志; 洪學義; 陳明庭; Huang, Chieh-chi; Tai, Hao-chih; Horng, Shyue-yih; Chen, Ming-ting; |
期刊 | 中華民國整形外科醫學會雜誌 |
出版日期 | 20000600 |
卷期 | 9:2 2000.06[民89.06] |
頁次 | 頁81-90 |
分類號 | 416.413 |
語文 | eng |
關鍵詞 | 硬膜外麻醉; 前外側股皮瓣; 下肢重建; Anterolateral thigh flap; Lower extremity reconstruction; Epidural anesthesia; |
中文摘要 | 自由皮瓣使用於下肢重建,需面對較高的併發症與失敗率,因為下肢血管,較易血管收縮,動脈硬化與血管栓塞。在1999年,有九位患者,在硬膜外麻醉下,以自由前外側股皮瓣,重建下肢缺損。其中八位男性,一位女性。年齡分佈從45至76歲。受傷機轉包括三位開放性骨折,三位壓碎傷,二位糖尿病足,一位電灼傷。先前疾病包括了,七位高血壓,四位糖尿病,四位慢性阻塞性肺部疾病。硬膜外麻醉使用Bupivacaine注射。其中八塊皮瓣存活(成功率89%)。一位重建膝關節開放性骨折患者,因術後感染而失敗。另一位術後產生皮瓣部分壞死,之後以裂層植皮修補。使用硬膜外麻醉,可避免長時間全身麻醉的危險,達到解除疼痛與血管舒張的效果。在下肢重建,使用自由前外側股皮瓣,可得到彈性的設計,多樣性組織可供使用,並且有微小供皮部併發症等優點。所以併用前外側股皮瓣與硬膜外麻醉,在下肢重建,成為很好的選擇。 |
英文摘要 | Despite improved surgical techniques, partial or total loss of the free flaps remains an obstacle for the lower extremity reconstruction. The risk factors of flap failure involve thrombosis, atherosclerosis, and vasospasm. In 1999, we performed nine cases of the lower leg reconstruction with the free anterolateral thigh flap under epidural anesthesia. There were eight male and one female aged from 45 to 76 years old (mean 59). The etiologies included open fracture (3), crush (3), diabetic ulcer (2), and electric burn (1). The underlying medical diseases included the hypertension (7), diabetes mellitus (4), and chronic obstructive pulmonary diseases (4). Bupivacaine was used for lumbar epidural anesthesia. Eight of the nine flaps survived (89%). One flap for reconstructing open fracture of the knee joint developed secondary infection and turned into complete necrosis later. Partial necrosis of the flap occurred in one flap (11.1%) and the STSG was done for resurfacing. Epidural anesthesia has the advantages of avoiding the risk of the prolonged general anesthesia, and achieving both pain relief and vasodilatation. The versatility of the flap design, providing various components of tissues, and minimal donor-site morbidity make the free anterolateral thigh flap very useful in the lower extremity reconstruction. |
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