游离髂腹股沟皮瓣修复手部皮肤软组织缺损  

Application of free ilioinguinal flap for repair of hand skin and soft tissue defects

作　　者：戚建武[1] 孙斌鸿[1] 刘林海[1] 柴益铜[1] 黄剑[1] 方炫量[1] 范学锴[1] 孙赫阳 王欣[1] 陈宏[1] Qi Jianwu;Sun Binhong;Liu Linhai;Chai Yitong;Huang Jian;Fang Xuanliang;Fan Xuekai;Sun Heyang;Wang Xin;Chen Hong(Department of Hand Surgely,Ningbo No.6 Hospital,Ningbo 315040,China)

机构地区：[1]宁波市第六医院手外科,315040

出　　处：《中华手外科杂志》2019年第1期12-15,共4页Chinese Journal of Hand Surgery

基　　金：浙江省医药卫生科技计划(2015ICYA203).

摘　　要：目的探讨个性化游离髂腹股沟皮瓣修复手部皮肤软组织缺损的临床疗效。方法自2013年1月至2017年12月,我们采用游离髂腹股沟皮瓣移植修复手部皮肤软组织缺损患者97例,其中旋髂浅动脉皮瓣63例(带髂骨的旋髂浅动脉复合皮瓣26例),腹壁浅动脉皮瓣15例,旋髂浅动脉和腹壁浅动脉联合皮瓣19例(分叶皮瓣7例)。皮肤缺损面积为4 cm×6 cm^11 cm×23 cm。术中皮瓣动脉与桡动脉终末支端端吻合5例,与桡动脉端侧吻合58例,与尺动脉端侧吻合20例,与指总动脉吻合14例;全部修复旋髂浅静脉或腹壁浅静脉(31例同时修复一根伴行静脉)。供区通过屈髋屈膝后均予直接缝合,无需植皮。术后3周、1.5个月、3个月、6个月、1年、2年随访观察供区的愈合情况及受区皮瓣外观和感觉恢复情况。结果97例皮瓣中94例顺利存活,术后1例皮瓣出现动脉危象、2例出现静脉危象,2例手术探查、1例保守治疗后1例顺利存活、2例皮肤坏死,二期切痂后发现皮下软组织成活,予全厚皮片植皮修复。腹部供区有1例联合皮瓣术后1周直立行走出现切口裂开,经二期缝合后愈合;余供区均Ⅰ期愈合。随访时间为0.5~1.5年,皮瓣质地软,轻度臃肿,感觉恢复至S2~S3,腹部供区仅留线性瘢痕。结论根据手部受区皮肤软组织缺损情况,采用个性化游离髂腹股沟皮瓣移植修复能满足受区的不同需要。并且供区隐蔽,切取面积大,能直接缝合,属于轴形皮瓣,血管恒定,切取方便,不破坏主要血管,手术时间短,因此是修复四肢皮肤软组织缺损较理想的方法之一。ObjectiveTo investigate the clinical effect of individualized free ilioinguinal flap in repairing hand skin and soft tissue defects.MethodsFrom January 2013 to December 2017,97 cases of hand skin and soft tissue defects were treated with free ilioinguinal flap.There were 63 cases of superficial circumflex iliac artery flap(26 cases of superficial circumflex iliac artery flap with iliac bone),15 cases of superficial abdominal artery flap and 19 cases of combined flap of superficial circumflex iliac artery and superficial abdominal artery(7 cases of lobulated flap).The area of skin defects ranged from 4 cm×6 cm to 11 cm×23 cm.During the operation,end to end anastomosis of flap artery and the end branch of radial artery in 5 cases,end to side anastomosis of radial artery in 58 cases,end to side anastomosis of ulnar artery in 20 cases,end to side anastomosis of common digital artery in 14 cases.All the superficial circumflex iliac veins and superficial abdominal veins were repaired(a concomitant vein were repaired at the same time in 31 cases).The donor site was sutured directly after flexion of hip and knee without skin grafting.Three weeks,1.5 months,3 months,6 months,1 year and 2 years after the operation,the healing of donor area and the appearance and sensory recovery of recipient area skin flaps were observed.ResultsPostoperatively 94 cases survived successfully.Arterial crisis occurred in 1 case and venous crisis in 2 cases.2 cases received surgical exploration and 1 case received conservative treatment.After that,1 case survived smoothly and 2 cases suffered skin necrosis.Subcutaneous soft tissue survived after secondary escharectomy and survived after skin grafting.In one case of abdominal donor site,the incision dehiscence occurred in the first week of walking upright after operation,and healed after secondary suture.The remaining donor sites achieved primary healing.The follow-up period ranged from 0.5 to 1.5 years.The flaps were soft and slightly swollen,and the sensation returned to S2 or S3.There were

关 键 词：手损伤 外科皮瓣 皮肤软组织缺损 游离 个性化 

分 类 号：R658.2[医药卫生—外科学]