游离穿支皮瓣在老年患者四肢皮肤缺损中的应用  

Application of free perforator flaps transfer in senile patients with limb skin defects

作　　者：杨科跃[1] 周丹亚[1] 潘佳栋[1] 胡瑞斌[1] 李学渊[1] 陈宏[1] 滕晓峰[1] 王欣[1] 

机构地区：[1]宁波市第六医院手外科, 浙江省宁波市,315040

出　　处：《中华显微外科杂志》2014年第1期17-21,共5页Chinese Journal of Microsurgery

基　　金：浙江省卫生厅项目（2011RCB035）;宁波市自然基金及社会发展项目（2011A610046）

摘　　要：目的 探讨应用游离穿支皮瓣修复老年患者四肢皮肤缺损的临床效果. 方法 对2008年1月至2012年11月收治的43例四肢皮肤缺损的老年患者进行基础疾病控制和游离穿支皮瓣移植修复,其中伴有高血压疾病15例,伴有糖尿病或糖耐量异常13例.皮肤缺损部位：足踝及胫前33例,手背、手腕或前臂10例,皮肤缺损面积2cmx3 cm～10cmx16cm.其中28例采用游离股前外侧皮瓣移植修复,7例采用游离腓肠内侧动脉穿支皮瓣移植修复,4例采用游离腓动脉穿支皮瓣移植修复,4例采用游离骨间后动脉穿支皮瓣移植修复.血管吻合采用端端法或端侧法. 结果 术后36例皮瓣未发生明显血管危象,3例皮瓣部分坏死,经换药后愈合；2例皮瓣出现静脉危象,经拆线、抬高患肢、局部应用解痉药物、二期缝合等处理后愈合；2例皮瓣局部感染,经扩创、换药后愈合.随访时间3～20个月（平均7.2个月）,7例皮瓣于术后半年行皮瓣修整手术,其余皮瓣质地、外形良好,皮瓣供区瘢痕挛缩不明显. 结论 只要积极处理基础疾病,严格掌握手术适应证,充分完善术前准备,严密观察术后病情变化并及时处理,应用游离穿支皮瓣移植修复老年患者四肢皮肤缺损亦能取得良好效果.Objective To explore the clinical effect of applications of free perforator flaps in repairing limb skin defect in senile patients.Methods From January 2008 to November 2012,forty-three senile patients with limb skin defects were treated by free perforator flaps transfer after the underlying diseases were controlled,in which 15 patients with hypertension,thirteen patients with diabetes or glucose tolerance abnormalities.Location of skin defect：thirty three cases were located in anterior ankle and tibia,ten cases were located in the dorsum of hand,wrist or forearm,and the size of skin defects were ranged from 2 cmx3 cm to 10 x16 cm.Twenty-eight cases were treated with free anterolateral thigh flaps transfer,seven cases were treated with free medial sural artery perforator flaps transfer,four cases were treated with free peroneal artery perforator flaps transfer,four cases were treated with free interosseous artery perforator flaps transfer.The blood vessels were anastomosed either end-to-end or end-to-side.Results There was no obvious vascular crisis in 36 cases.Partial necrosis occurred in 3 cases and all healed after dressing changes.Venous crisis occurred in 2 cases,and healed after treated by removing stitches,raising the limb,spasmolysis drugs local injecting; Flap partial infections occurred in 2 cases,and healed after debridement and dressing changes.All the cases were followed up for 3 to 20 months （7.2 months on average）.Seven cases were performed flap trimming after 6 months,and the appearance and quality of the other flaps were satisfied.The scars of the donor site was not obvious.Conclusion With active treatment of the underlying diseases,strict surgical indications control,adequate preoperative preparation,close observation of the changes in the postoperative condition and timely processing,application of free perforator flaps transfer in repairing limb skin defects in senile patients also achieved good results.

关 键 词：老年患者 四肢 穿支皮瓣 显微外科手术 

分 类 号：R622.1[医药卫生—整形外科]