拱顶石穿支岛状皮瓣在皮肤软组织缺损修复中的应用  

The keystone design perforator island flap in reconstructive surgery

作　　者：杨超[1] 邢新[1] 徐建国[1] 徐苗[1] 方硕[1] 孙肇晟[1] 

机构地区：[1]全军整形外科中心、第二军医大学附属长海医院整形外科上海200433

出　　处：《中华整形外科杂志》2014年第1期10-13,共4页Chinese Journal of Plastic Surgery

摘　　要：【摘要】目的探讨拱顶石穿支岛状皮瓣修复皮肤软组织缺损的临床效果。方法2012年6月至2013年6月，设计应用拱顶石穿支岛状皮瓣（keystonedesignperforatorislandflap，KDPIF）修复四肢、躯干及面部皮肤软组织缺损14例，缺损面积为1cm×1cm-5cm×9cm。术中于缺损旁设计拱形皮瓣，皮瓣宽度与缺损宽度一致，皮瓣紧邻创缘的两侧顶角呈90。，在该皮瓣的头尾两端包含2个V—Y推进皮瓣。皮瓣血供主要来自皮下血管网和来自筋膜及肌肉的穿支血管，对于一些面积较大的皮瓣，术前可通过多普勒确定皮瓣基底穿支血管的位置。结果本组13例患者创面一期愈合，仅1例出现皮瓣部分坏死，经换药后二期愈合。术后随访3—6个月，患者对形态和功能均感满意。结论拱顶石穿支岛状皮瓣为皮肤软组织缺损创面的修复提供了一种简单、有效的方法，对于一些可能原本需要复杂皮瓣或移植皮片修复的创面亦适用。Objective To introduce the experience in skin defects reconstruction using keystone design perforator island flap.Methods Since June 2012 to June 2013,the flaps have been used in 14 patients.The size of defects ranged from 1 cm × 1 cm to 5 cm × 9cm at the extremities,trunk and facial region.The trapezoidal shaped flap has the same width as the defect.The flap is designed along the edge of the defect with 90° angle at the ends of the island flap.This curvilinear-and trapezoidal-shaped flap essentially consists of two conjoined V-Y advancement flaps at the proximal and distal end.The vascular supply is supported by the subcutaneous vascular network and fascial/muscular perforators.Perforators should be detected by Doppler techniques when large size flaps are used.Results Primary wound healing and satisfactory result was achieved in 13 patients except for one with partial flap necrosis.Conclusion The technique offers a simple and effective method of wound closure in situations that would otherwise have required complex flap closure or skin grafting.

关 键 词：【关键词】拱顶石穿支岛状皮瓣 缺损 重建 

分 类 号：R622[医药卫生—整形外科]