“感叹号”状带蒂皮瓣的设计与临床应用  

Design and clinical application of ＂exclamation mark＂ shaped pedicle flaps

作　　者：雷林革[1] 厉孟[2] 何如祥[1] 沈美华[1] 李国海[1] 

机构地区：[1]解放军第一医院手足外科,兰州730030 [2]兰州军区总医院骨科

出　　处：《中华创伤杂志》2012年第9期826-829,共4页Chinese Journal of Trauma

摘　　要：目的探讨带蒂皮瓣蒂部处理方法对皮瓣成活和外观的影响。方法2009年10月-2011年1月，将传统带蒂旋转皮瓣设计为“网球拍”形，旋转蒂部设计成圆形减张小皮瓣和带蒂旋转皮瓣组成“感叹号”状皮瓣，旋转修复四肢软组织缺损共17例。其中上肢3例，下肢14例。皮肤缺损面积4．0cm×7．2cm-5．8cm×14．0cm。采用桡神经浅支营养血管皮瓣2例，尺动脉腕上皮支皮瓣1例，腓肠神经营养血管皮瓣8例，隐神经营养血管皮瓣6例。结果除1例皮瓣术后远端部分坏死，经换药后愈合，其余皮瓣均I期愈合，随访6个月～1年，愈后皮瓣无明显臃肿，蒂部旋转点外形好。结论“感叹号”状皮瓣可减少远端蒂皮瓣蒂部卡压，促进静脉回流，提高带蒂旋转皮瓣的成活率，并改善其外观。Objective To investigate effects of pedicle processing methods on the survival and appearance of the pedicle flaps. Methods The study involved 17 patients with soft tissue defects of extremities treated with the ＂exclamation mark＂ shaped pedicle flaps from October 2009 to January 2011. The traditional pedicled rotation flaps was designed to be a tennis racket-like shape, then the rotational pedicle was designed to small round tension reduction flap and pedicled rotation flaps, which contributed to formation of the ＂exclamation mark＂ shaped pedicle flaps. The soft tissue defects was located at the upper extremity in three patients and at lower extremity in 14, with defect areas of 4.0 cmx 7.2 cm-5.8 cm ~ 14.0 cm. There used two superficial radial nerve vasotrophic flaps, one ulnar artery supra-carpal cutaneous flap, eight sural ncm＇ocutaneous vasotrophic flaps and six saphenous nerve vasotrophic flaps. Results All flaps survived at I stage except that one flap had partial distal necrosis postoperatively, which was cured after dress change. The follow-up ranged from six months to one year, which showed un- obvious swelling of the survived flaps and good appearance of the rotation point of the pedicle. Conclusion The ＂exAamation mark＂ shaped pedicle flaps can reduce entrapment of the distal pedicle, pro- mote venous drainage, improve survival and modify the appearance of the flaps.

关 键 词：软组织损伤 外科皮瓣 减张皮瓣 

分 类 号：R658[医药卫生—外科学]