Abstract: Objective    To investigate the effect of the application of the ladder decompression with the blood-driven bandage in the preparation of the free fibular flap. Methods    From December 2020 to August 2022，79 patients who needed free fibular flap transplantation were selected from the Department of Head and Neck Surgery，West China Stomatological Hospital，Sichuan University. Totally 25 patients hospitalized from December 2020 to May 2021 were included in the control group（no ladder decompression was performed during operation），and 30 patients hospitalized from June 2021 to November 2021 were included in the ladder decompression group（ladder decompression was performed）. Totally 24 patients hospitalized from December 2021 to August 2022 were included in the one-step group（remove the pressure at one-time）. The operation time of fibula flap preparation，the blood loss of fibula flap preparation operation area，the overall operation time，the blood loss of the whole operation area，the wound closure time of fibula flap area，the length of fibula flap preparation，the length of soft tissue incision，the hemoglobin amount on the first day after operation，the visual analogue scale（VAS）score after operation，the total drainage amount after operation and the first，second，third and fourth day after operation were recorded and compared among the three groups. Results    There were significant differences among the three groups in the operation time of fibular flap preparation，the blood loss of fibular flap preparation operation area，the wound closing time of fibular flap area，the total drainage volume after operation，the drainage volume on the first day after operation，and the drainage volume on the second day after operation（all P < 0.05）. The operation time of fibular flap preparation and the blood loss of fibular flap preparation in the one-step decompression group and the cascade decompression group were less than those in the control group. The fibular flap closure time，the total postoperative drainage volume，the postoperative drainage volume on the first day and the postoperative drainage volume on the second day in the cascade decompression group were less than those in the control group，and the differences were statistically significant（all P < 0.05）. The blood loss，wound closure time，drainage volume on the first day after operation and total drainage volume after operation in the cascade decompression group were significantly less than those in the one-step decompression group（all P < 0.05）. All patients were healed by first intention，and there were no complications such as fibular flap necrosis，increased postoperative bleeding，wound infection and so on. Conclusion    Compared with the one-step method and the method without using the blood-driven bandage，the ladder decompression method with the blood-driven bandage can reduce the amount of blood loss in the fibular flap preparation area during the operation，and does not increase the risk of other adverse reactions. 

Key words: ladder decompression of blood-driven bandage, preparation of fibula flap, bleeding volume, time of preparation

摘要： 目的    探讨驱血带梯式减压法在制备游离腓骨瓣中的应用效果。方法    选取2020年12月至2022年8月于四川大学华西口腔医院头颈肿瘤外科住院的需行腓骨瓣游离移植术患者79例。将2020年12月至2021年5月住院的25例患者纳入对照组（术中未行驱血带减压），2021年6—11月住院的30例患者纳入梯式减压法组（术中驱血带分2次梯式减压），2021年12月至2022年8月住院的24例患者纳入一步法组（术中驱血带一次性减压）。记录并比较3组患者制备腓骨瓣手术时间、制备腓骨瓣手术区域出血量、整体手术时间、全手术区域出血量、腓骨瓣区域关创时间、制备腓骨瓣长度、软组织切口长度、术后第1天血红蛋白量、术后视觉模拟量表（VAS）评分、术后总引流量及术后第1、2、3天引流量的差异。结果    在制备腓骨瓣手术时间、制备腓骨瓣手术区域出血量、腓骨瓣区域关创时间、术后总引流量、术后第1、2天引流量方面，3组间总的比较，差异均有统计学意义（均P < 0.05）。其中，一步法组和梯式减压法组的制备腓骨瓣手术时间、制备腓骨瓣手术区域出血量均小于对照组，梯式减压法组的腓骨瓣区域关创时间、术后总引流量、术后第1、2天引流量均小于对照组，差异均有统计学意义（均P < 0.05）；梯式减压法组的制备腓骨瓣手术区域出血量、腓骨瓣区域关创时间、术后第1天引流量及术后总引流量均小于一步法组，差异均有统计学意义（均P < 0.05）。且所有患者均一期愈合，未出现腓骨瓣坏死、术后出血、创口感染等并发症。结论    使用驱血带梯式减压法制备游离腓骨瓣与驱血带一步法和未使用驱血带相比，可降低术中腓骨瓣制备区域出血量，且未增加其他不良反应的发生风险。

关键词: 驱血带梯式减压, 腓骨瓣制备, 出血量, 制备时间