特殊类型穿支皮瓣在创伤骨科的临床应用  

Clinical application of special forms of perforator flaps in orthopedic trauma

作　　者：唐举玉[1] 吴攀峰[1] 俞芳[1] 梁捷予[1] 卿黎明[1] 王聪杨[1] 符劲飞 

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008

出　　处：《中华创伤杂志》2014年第11期1085-1088,共4页Chinese Journal of Trauma

摘　　要：目的 探讨特殊穿支皮瓣修复四肢皮肤软组织缺损的临床效果、适应证与注意事项.方法 选择2008年1月-2013年12月应用特殊类型穿支皮瓣修复四肢皮肤软组织缺损480例.特殊类型穿支皮瓣包括血流桥接穿支皮瓣、显微削薄穿支皮瓣、联体穿支皮瓣、分叶穿支皮瓣和嵌合穿支皮瓣,衍生类型包括5种基本类型中的2种或3种皮瓣的组合.结果 术后10例皮瓣发生静脉危象,经再次手术探查证实5例系吻合口栓塞,2例系血管蒂扭转,3例系皮瓣下血肿所致,经相应处理后全部成活4例,部分坏死6例.术后感染12例,其中1例术后第5天继发动脉危象而致皮瓣全部坏死;其余皮瓣顺利成活,创口Ⅰ期愈合;皮瓣供区8例皮瓣转移修复,3例植皮修复,其余供区均直接闭合.结论 特殊类型穿支皮瓣是修复四肢皮肤软组织缺损的理想方法.Objective To investigate the clinical results,indications and precautions of a variety of special forms of the perforator flap for reconstructing limb soft-tissue defect.Methods From January 2008 to December 2013,480 cases suffering from limb soft-tissue defect were treated with special forms of the perforator flap.Types of special forms of the perforator flap included flow-through perforator flaps,micro-dissected perforator flaps,conjointed perforator flaps,polyfoliate perforator flaps and chimeric perforator flaps.Derivative types combined two or three technologies used in basic types.Results Venous crisis of the flap was shown in 10 cases.Through a second surgical exploration,5 cases were diagnosed with anastomotic thrombosis,2 with vascular torsion and 3 with hematoma.After appropriate treatments,flaps survived in 4 cases,but partial necrosis occurred in 6 cases.Twelve cases were found to have infection,which led to arterial crisis followed by total flap necrosis in one of them at postoperative day 5.Other flaps survived and wounds healed by first intention.Donor sites were repaired by skin flap transfer in 8 cases,skin grafting in 3 cases and direct suture in the rest cases.Conclusion Special forms of the perforator flap are optimal for repair of soft-tissue defect of extremities.

关 键 词：软组织损伤 皮肤 外科皮瓣 四肢 

分 类 号：R641[医药卫生—外科学]