儿童与成人腓动脉穿支筋膜蒂皮瓣修复小腿不同部位皮肤软组织缺损的疗效比较  

Distally based perforator.plus sural fasciocutaneous flap for repair of lower leg soft.tissue defects in pediatrics and adults

作　　者：王璋斌[1] 董忠根[2] 武文臣[1] 刘立宏[2] 魏建伟[2] 罗顺红[2] 

机构地区：[1]长治医学院附属和济医院骨科,046011 [2]中南大学湘雅二医院骨科

出　　处：《中华创伤杂志》2016年第9期823-828,共6页Chinese Journal of Trauma

摘　　要：目的比较儿童与成人腓动脉穿支筋膜蒂皮瓣的修复小腿不同部位皮肤软组织缺损的效果。方法回顾性分析2001年4月-2011年2月收治的165例远端蒂腓动脉穿支筋膜蒂皮瓣患者资料，其中男125例，女40例；年龄3～78岁。根据患者年龄将患者分为儿童组（年龄〈14岁，50例）和成人组（年龄≥17岁，115例）。两组均通过顺逆结合法切取皮瓣，比较两组皮瓣并发症及其影响因素（包括性别、缺损部位、伤因、旋转点及近端位置）。随访超过12个月患者，比较皮瓣修复效果、皮瓣供区并发症及肢体肿胀情况。结果所有患者均获得随访2周～72个月。儿童组皮瓣部分坏死率（14％）、边缘坏死率（4％）及总并发症率（18％）均稍高于成人组相应指标（11．3％、1．7％及13．0％），但差异均无统计学意义（P〉0．05）。两组性别构成比、旋转点位置及近端位置的差异无统计学意义（P〉0．05）。儿童组缺损部位位于小腿下段前方的构成比低于成人组，而位于跟腱、踝区的构成比高于成人组，差异有统计学意义（P〈0．05）。儿童组轮辐伤的构成比高于成人组，而砸压伤、运动伤的构成比均低于成人组，差异有统计学意义（P〈0．05）。两组皮瓣修复效果比较，差异无统计学意义（P〉0．05）。儿童组皮瓣供区瘢痕增生及皮肤瘙痒发病率显著高于成人组，但下肢早期肿胀发生率显著低于成人组，差异有统计学意义（P〈0．05）。结论儿童与成人腓动脉穿支筋膜蒂皮瓣的成活可靠性及修复效果均较好。儿童较成人易发生腓动脉穿支筋膜蒂皮瓣供区瘢痕增生及皮肤瘙痒。Objective To compare the effect of distally based perforator-plus sural fasciocutaneous flap for soft tissue reconstruction of the lower leg in pediatric and adult populations. Methods Data of 165 patients treated with distally based perforator-plus sural fasciocutaneous flap between April 2001 and February 2011 were retrospectively reviewed. There were 125 males and 40 females, at age range of 3- 78 years. The patients were divided into pediatric group （ 〈 14 years, n = 50 ） and aduh group （ I〉 17 years, n = 115） according to the age. The two groups were compared in terms of flap-viability-related complications （partial necrosis, marginal necrosis and overall complication rate） and their potential risk factors（ sex, location of defect, causes of defect, pivot point site and top-edge location）. For the patients followed at least 12 months, the reconstruction outcomes, donor-site morbidities（hypertrophic scar, pruritus, pigmentation, numbness of skin graft area and paresthesia of skin graft area）, and swelling of the limb were compared between the groups. Results All patients were followed up for 2 weeks to 72 months. Partial necrosis of the flap, marginal necrosis of the flap, and overall complications in pediatric group accounted for 14% , 4% and 18% respectively, higher than 11.3% , 1.7% and 13.0% in adult group, but the differences were insignificant （P 〉 0.05 ）. Sex ratio, pivot point site and top-edge location were not significantly different between the groups （ P 〉 0.05 ）. Pediatric group versus adult group presented a significantly lower proportion of pretibial defects, but significantly higher proportions of the defects over the achilles tendon and heel （ P 〈 0.05 ）. A significantly higher proportion of spoke injury and lower proportions of tamp injury and sports injury were observed in pediatric group than in adult group （ P 〈 0.05 ）. Reconstruction outcomes were not significantly different between the groups （P 〉 0.05 ）. Pediatric group versus adult

关 键 词：外科皮瓣 手术后并发症 腓肠神经 儿童 

分 类 号：R658.3[医药卫生—外科学] R726.5[医药卫生—临床医学]