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1、56例皮片、皮瓣移植坏死原因分析ClinicalAnalysisofthecausesofnecrosisin56casesofskingraftingandflaptransplantation作者姓名：石延鹏专业名称：外科学指导教师：宣昭鹏副教授学位类别：临床医学硕士答辩日期：2015年05月28日中文摘要56例皮片、皮瓣移植坏死原因分析目的：分析皮片、皮瓣坏死的原因，总结经验，提高皮片移植、皮瓣转移修复术成功率。方法：回顾性分析2005年12月至2014年12月发生皮片、皮瓣坏死病例共56例，其中皮片移植术后坏死9例，皮瓣术后坏死（包含部分坏死和全部坏死）47例，根据术前评估患者、
2、手术时机选择、手术方式选择、皮片的分类、皮瓣的分类、操作方法、术中见患者个体是否有差异以及术后处理等方面进行分析研究。结果：皮片移植坏死原因中，皮片选择不当5例，皮片移植方法不当2例，术后处理不当2例；皮瓣坏死原因中，手术时机选择不当7例，皮瓣设计不合理15例，操作失误18例，术后处理不当7例。结论：术前对病情的准确评估，手术时机的准确判断，手术方式的合理选择，术中精细操作及良好的术后处理，是皮片移植、皮瓣手术成功的关键。关键词皮片移植，外科皮瓣，移植，并发症，显微外科IAbstractClinicalAnalysisofthecausesofnecrosisin56casesofski
3、ngraftingandflaptransplantationObjective:Toanalyzethecausesofnecrosisinskingraftingandflaptransplantation,togatherexperience,andtoimprovethesuccessratesofskingraftingandflaptransplantation.Methods:Aretrospectiveanalysiswasconductedinwhichpartialorcompletenecrosisoccurredin56casesofskingraftingand
4、flaptransplantationfromDecember2005toDecember2014.9caseswithskingraftingand47caseswithflaptransplantationwereincluded.Weanalyzedthecausesofnecrosisaccordingtopreoperativeevaluation,surgicaltiming,surgicalmethods,theclassificationofskingrafting,theclassificationofflaptransplantation,surgicalproced
5、ure,individualdifferenceandpostoperativemanagement.Results:Inthecaseswithnecrosisofskingrafting,5caseswerecausedbyselectingthewrongkindsofskingraft,andimpropersurgicalmethodsandpostoperativemanagementcaused2casesrespectively.Inthecaseswithnecrosisofflaptransplantation,therewere7casescausedbywrong
6、surgicaltiming,15casescausedbytheinappropriateflapdesign,18casescausedbyfailureofsurgicalprocedureandII7casescausedbyincorrectpostoperativemanagement.Conclusions:Accuratepreoperativeevaluationandselectioninsurgicaltiming,withrationalsurgicalmethods,carefulsurgicalprocedureandproperpostoperativema
7、nagement,arethekeyrolestoimprovethesuccessratesofskingraftingandflaptransplantation.Keywords:skingrafting,surgicalflaps,transplantation,complications,microsurgeryIII目录第1章绪论..............................................
