[目的]观察游离皮瓣远心端静脉插管持续局部抗凝,预防血管危象,提高吻合血管通畅率的可能性。[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、下颌骨癌等切除组织缺损的病例共105例,年龄最大79岁,最小26岁,皮瓣最大8.0cm×13cm,最小5.0cm×7.0cm。采用皮瓣远端头静脉插管留置,输注低分子右旋糖酐,20ml/h,持续7d,术中根据需要灌注25u/ml肝素生理盐水共51例,对照病例组54例,按常规术后全身给予低分子右旋糖酐500ml静脉滴注,每24h1次和罂粟碱30mg肌肉注射,每8h1次,抗凝及扩血管处理。[结果]经静脉插管抗凝处理组51例,皮瓣全部存活,未出现血管危象;对照病例组54例,2例出现静脉危象,抢救无效皮瓣坏死。[结论]经静脉插管抗凝处理能有效预防静脉血栓形成,提高皮瓣成活率。通过观察皮瓣远端静脉插管的液体滴注情况方便了解血管通畅状态,特别适用位于皮下无皮岛的深部组织瓣血供观察。 [Objective] To observe the continuous local anticoagulation of distal flaps with distal venous cannulation to prevent vascular crisis and improve the possibility of anastomotic vascular patency. [Method] A total of 105 cases of resected tissue defects such as tongue, cheek and mandibular cancer were treated with free transplantation of forearm flap, peroneal skin flap and ilium musculocutaneous flap, with a maximum age of 79 years and a minimum of 26 years. Flaps up to 8.0cm × 13cm, the smallest 5.0cm × 7.0cm. Using distal femoral vein cannulation catheter, infusion of low molecular weight dextran, 20ml / h, for 7d, according to need intraoperative perfusion of 25u / ml heparin saline in 51 cases, the control group of 54 patients, according to conventional postoperative systemic Given low molecular weight dextran 500ml intravenous infusion, and intramuscular injection of papaverine 30mg every 24h1 times, every 8h1 times, anticoagulant and vasodilator. [Results] In the group of 51 cases treated with anticoagulant anticoagulation, the flaps all survived without any vascular crisis. In the control group, 54 cases showed venous crisis in 2 cases and the necrosis of the invalid flap was rescued. [Conclusion] Intravenous anticoagulation can effectively prevent venous thrombosis and improve the survival rate of the flap. By observing the situation of fluid instillation in the distal venous cannula of the flap, it is convenient to know the state of the blood vessel patency, especially for the deep tissue flap blood located in the subcutaneous and dermal island.