蒂部减张皮瓣在远端蒂皮瓣中的应用  

APPLICATION OF PEDICLE REDUCING TENSION FLAP IN THE DISTALLY-BASED PEDICLE FLAP OPERATION

作　　者：雷林革[1] 何如祥[1] 沈美华[1] 程鹏[1] 李国海[1] 闫宛春[1] 

机构地区：[1]解放军第一医院手足外科,兰州730030

出　　处：《中国修复重建外科杂志》2012年第1期58-60,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨蒂部减张皮瓣处理方法对远端蒂皮瓣成活及外观的影响。方法 2009年10月-2011年2月,采用蒂部减张皮瓣的方法利用远端蒂皮瓣移位修复四肢皮肤软组织缺损27例。男19例,女8例;年龄17～58岁,平均31.5岁。致伤原因:交通事故伤14例,机器绞伤9例,外科感染3例,肿瘤切除后1例。缺损部位:胫骨下段7例,踝关节12例,足部5例,手掌2例,手背1例。伤后至入院时间1～19 h,平均10 h。创面范围5.2 cm×3.8 cm～14.0 cm×5.8 cm。远端蒂皮瓣切取范围5.5 cm×4.5 cm～14.5 cm×6.5 cm。供区直接缝合6例,游离植皮21例。结果术后蒂部减张皮瓣均顺利成活。3例术后7 d远端蒂皮瓣发生部分坏死,经换药后1例行游离植皮,2例切除坏死皮缘后直接缝合后愈合;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,植皮均成活。术后26例获随访,随访时间6～12个月,平均7.5个月。皮瓣质地、外观均良好。结论应用蒂部减张皮瓣可促进远端蒂皮瓣成活,并改善修复后外观。Objective To explore the effectiveness of reducing tension method on the survival and appearance of distally-based pedicle flap.Methods Between October 2009 and February 2011,27 cases of defect of extremity skin and soft tissue were repaired with distally-based pedicle flap through reducing tension flap method.There were 19 males and 8 females with an average age of 31.5 years（range,17-58 years）.Defects were caused by traffic accident in 14 cases,by machine in 9 cases,by surgical infection in 3 cases,and by tumor excision in 1 case.The locations were the distal tibia in 7 cases,the ankle-joint in 12 cases,the foot in 5 cases,the palm in 2 cases,and the dorsum of hand in 1 case.The time from injury to hospitalization was 1-19 hours with an average of 10 hours.The size of defect ranged from 5.2 cm × 3.8 cm to 14.0 cm × 5.8 cm.The size of distally-based pedicle flap ranged from 5.5 cm × 4.5 cm to 14.5 c m × 6.5 cm.The donor sites were sutured directly in 6 cases and were repaired with skin grafting in 21 cases.Results All reducing tension flaps survived.Partial necrosis occurred in the distally-based pedicle flap in 3 cases at 7 days after operation,which was cured after dressing change and skin grafting in 1 case,after excision of necrosis skin edge and direct suture in 2 cases.The other flaps survived and wounds achieved primary healing.The incisions at donor sites healed by first intention and skin grafting survived.Twenty-six cases were followed up 6-12 months（mean,7.5 months）.The appearance and texture of the flaps were good.Conclusion Pedicle reducing tension flap could promote the survival and the appearance of distally-based pedicle flap.

关 键 词：远端蒂皮瓣 蒂部减张皮瓣 软组织缺损 创面修复 

分 类 号：R658.3[医药卫生—外科学]