旋股外侧动脉降支穿支皮瓣修复上肢电击伤创面  

Repair of electrical wound injury in upper limbs with perforator flap pedicled with the descending branch of lateral circumflex femoral artery

作　　者：孙鹏[1] 战杰[1] 王思夏[1] 吴锦生[1] 马俊伟[1] Sun Peng;Zhan Jie;Wang Sixia;Wu Jinsheng;Ma Junwei(Department of Hand Surgery,The Affiliated Central Hospital of Shenyang Medical College,Shenyang 110024,China)

机构地区：[1]沈阳医学院附属中心医院手外四科,沈阳110024

出　　处：《中华显微外科杂志》2019年第5期446-449,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨应用旋股外侧动脉降支穿支皮瓣修复上肢电击伤创面的临床效果。方法2014年8月至2018年7月,应用旋股外侧动脉降支穿支皮瓣修复上肢电击伤创面10例11侧,男9例(10侧),女1例(1侧)。单左侧上肢3例,单右侧上肢6例,双侧上肢1例。皮瓣切取面积为12 cm×6 cm^26 cm×11 cm。穿支皮瓣的动脉、静脉、皮神经分别与受区动脉、静脉、皮神经分别行吻合和缝接,10例11处供区均一期直接缝合。术后门诊随访,内容包括皮瓣成活情况、质地、外观、感觉恢复及供区愈合与瘢痕增生情况。结果10例(11侧)皮瓣全部成活,未发生血管危象。1例(1侧)发生感染,通过应用有效抗生素及加强换药的抗感染治疗,术后19 d创口愈合。术后随访4~24个月,皮瓣血运良好,质地与受区相近,外形满意,无明显臃肿,未发现皮瓣溃疡形成。皮瓣内均保留股前外侧皮神经并与受区的皮神经缝接,皮瓣感觉恢复S3级3块,S2级7块,S1级1块。皮瓣供区一期美容缝合,术后呈线形瘢痕,位置隐蔽,无骨筋膜室综合征发生。结论旋股外侧动脉降支穿支皮瓣血管解剖位置恒定,切取范围大,血运丰富,外观良好,供区隐蔽,是修复电击伤创面的良好选择。Objective To investigate the clinical effect of repairing the electrical wound of upper limbs by using the perforator flap pedicled with the descending branch of lateral circumflex femoral artery.Methods From August,2014 to July,2018,the perforator flap pedicled with the descending branch of lateral circumflex femoral artery was used to repair the electrical wound of the upper limbs in 10 cases(11 sides),which were 9 cases(10 sides)in males,1 case(1 side)in female.Three cases in the left side,6 cases in the right side,and 1 case in both sides.The area of the flap was 12 cm×6 cm-26 cm×11 cm.The arterial,venous and cutaneous nerves of the perforator flap were anastomosed with those of the recipient area,respectively.The patients were followed-up in outpatient depatment,including flap survival,texture,appearance,sensory recovery,donor site healing and scar hyperplasia.Results All the flaps survived without vascular crisis.Infection occurred in 1 case(1 side).The wound was healed 19 d after the operation by using effective antibiotics and dressing change.All cases were followed-up for 4-24 months after the operation.The blood supply of the flaps was good,the texture was similar to that of the recipient area,and the appearance was satisfactory.There was no obvious bloat,and no ulceration of the flap was found.The anterolateral femoral cutaneous nerve was retained in the flap and anastomosed with the cutaneous nerve in the recipient area.The sensory recover to S3 in 3 flaps,S2 in 7 flaps,S1 in 1 flap.The donor site of the flap was sewn up with aesthetic treatment.After the operation,the donor sites presented a linear scar with a concealed position and no occurrence of osteofascial compartment syndrome.Conclusion The perforator flap pedicled with the descending branch of lateral circumflex femoral artery has a constant anatomical position of perforator vessel,a wide excision range,abundant blood supply,a good appearance and a hidden donor site,which is a good choice for repairing the electrical wound.

关 键 词：电击伤 降支 旋股外侧动脉 穿支皮瓣 上肢 

分 类 号：R65[医药卫生—外科学]