髂腹股沟联体穿支皮瓣移植修复上肢较大面积皮肤缺损  

Ilioinguinal conjoined perforator flap transplantation for repairing large skin defects of the upper extremity

作　　者：顾荣 王海文 江新民 梅雄军 钟达强 

机构地区：[1]广州新江南手外科医院,广州510288

出　　处：《中华显微外科杂志》2017年第5期433-437,共5页Chinese Journal of Microsurgery

基　　金：广州市医药卫生科技项目（20161A010106）

摘　　要：目的探讨旋髂浅动脉浅支与第四腰动脉前支皮穿支或与肋间后动脉外侧穿支联体的髂腹股沟皮瓣移植修复前臂较大面积皮肤缺损的方法及临床疗效。 方法2005年4月至2015年8月，对6例上肢较大面积皮肤软组织缺损的创面，采用旋髂浅动脉浅支与第四腰动脉前支皮穿支或与肋间后动脉外侧穿支联体的髂腹股沟皮瓣移植进行修复，皮瓣近端以旋髂浅动脉浅支为血供，远端以第四腰动脉前支皮穿支或肋间后动脉外侧穿支为血供，皮瓣最大为35.0 cm×15.0 cm，最小为25.0 cm×9.0 cm。皮瓣供区均直接缝合。术后6例进行回院随访，观察皮瓣的外观、质地、功能及供区情况。 结果术后皮瓣全部成活，术后随访6~24个月，皮瓣厚薄适中，外形良好，质地柔软，皮瓣恢复保护性感觉，有排汗功能。皮瓣供区仅留线状瘢痕。 结论游离旋髂浅动脉浅支与第四腰动脉前支或与肋间后动脉外侧穿支联体的髂腹股沟穿支皮瓣可以扩大皮瓣的切取范围，为皮瓣提供良好血供，皮瓣具质地较簿、供区可直接缝合等优点，是修复上肢较大面积皮肤软组织缺损的一种理想方法。ObjectiveTo evaluate the clinical efficacy of ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery, the anterior fourth lumbar artery or the posterior intercostal artery.MethodsBetween April, 2005 to August, 2015, 6 patients diagnosed as large skin defects in the upper extremity were treated with ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery, the anterior fourth lumbar artery or the posterior intercostal artery. The proximal flap blood supply was offered by the superficial circumflex iliac artery, and the distal flap blood supply was provided by the anterior fourth lumbar artery or the posterior intercostal artery. The maximal size of the flap was measured as 35.0 cm×15.0 cm, and the minimal size was 25.0 cm×9.0 cm. The donor sites of the flap were directly sutured. All cases were implemented by postoperative follow-up visit in hospital for observation of appearance, texture, functions and donor site of flaps.ResultsPostoperatively, all flaps survived. The follow-up time endured for 6 to 24 months. The flap thickness was appropriate with normal shape and soft texture. Protective sensation and perspiration function of the flap were restored. Linear scars alone were observed in the donor sites of the flap.ConclusionIlioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery, the anterior fourth lumbar artery or the posterior intercostal artery can extend the excision scope of the flap and provides sufficient blood supply for the flap. The flap texture is soft and can be directly sutured. This technique is an ideal option for repairing of large soft tissue defects of the upper extremity.

关 键 词：穿支皮瓣 联体 旋髂浅动脉 肋间后动脉 第四腰动脉 

分 类 号：R658.2[医药卫生—外科学]