肋间后动脉穿支螺旋桨皮瓣修复躯干皮肤软组织缺损  

Reconstruction of trunk soft-tissue defect using the propeller flaps based on the perforators of the posterior intercostal artery

作　　者：朱珊 刘元波 于胜吉[2] 臧梦青 陈博 丁强 张健华 赵振国[2] 徐立斌[2] 张鑫鑫[2] 

机构地区：[1]中国医学科学院整形外科医院整形十一科,北京100144 [2]中国医学科学院肿瘤医院骨肿瘤科

出　　处：《中华整形外科杂志》2016年第2期98-102,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨应用肋间后动脉穿支蒂螺旋桨皮瓣修复躯干皮肤软组织缺损的可行性。方法根据躯干缺损的大小、形状和位置，应用便携式多普勒超声血流探测仪对肋间后动脉穿支血管进行定位，以选定的穿支血管为蒂，皮瓣最远端到穿支血管的距离略大于穿支血管到缺损最远端之间的距离，掀起穿支皮瓣，以穿支血管所在的位置为旋转点，旋转一定角度修复躯干缺损，供瓣区直接拉拢缝合。结果2009年10月至2015年10月，共为22例患者实施肋间后动脉穿支蒂螺旋桨皮瓣手术。所应用的穿支血管包括肋间后动脉椎骨段穿支2例、肋骨沟段背外侧肌皮穿支8例、肋骨沟段外侧皮支穿支7例、肌内段肌皮穿支4例和肋下动脉穿支1例，皮瓣面积为12cm×4cm～30cm×10cm，穿支血管蒂长度3．5～7．0cm，平均4．8cm，穿支皮瓣旋转180°15例、150。4例、90°3例。术后19例患者皮瓣全部成活；3例术后出现皮瓣血运障碍，其中2例尖端部分坏死，分别应用植皮和再次转移1个穿支皮瓣的方法进行修复，1例皮瓣全部坏死，移植皮片修复创面。随访1～5年，平均3．5年，体表恶性肿瘤患者未见肿瘤复发，所有患者对手术效果满意。结论对于中等大小的胸背部皮肤软组织缺损，采用肋间后动脉穿支蒂螺旋桨皮瓣修复是可行的方法。Objective To explore the feasibility and technical tips of the posterior intercostal artery perforator （ PICAP） flaps for trunk defect reeonstruction. Methods The PICAPs were thoroughly explored with the hand-held ultrasound Doppler. According to the size, shape and location of the defect, a perforator flap was raised based on the chosen PICAP, rotated in a certain degree and used to reconstruct the torso defect. Results From October 2009 to October 2015, 22 patients underwent defect reconstruction using the PICAP propeller flaps. The chosen perforators derived from the vertebral segments of the posterior intercostal arteries in 2 patients, from costal groove segments in 15, from intermuscular segments in 4, and from subcostal artery in 1. The skin paddle dimension ranged from 12 cm× 4 cm - 30 cm× 10 cm. The length of the perforator pedicle was 3.5 -7.0 cm （average 4.8 cm）. The flaps were rotated 180° in 15 patients, 150° in 4 patients, and 90° in 3 patients. 19 flaps survived completely. Distal partial flap necrosis occurred in two flaps and total flap necrosis in one. All wounds at donor sites were closed directly. The patients were followed up for 1 to 5 years （average 3.5 years ） with satisfactory outcomes and no tumor recurrence. Conclusions The PICAP propeller flap provides a valuable option for different torso defects reconstruction.

关 键 词：穿支皮瓣 螺旋桨皮瓣 肋间后动脉 躯干 

分 类 号：R622[医药卫生—整形外科]