双蒂皮瓣在复杂软组织缺损创面修复中的应用  

Application of bi-pedicle flap in repair of complex soft-tissue-defect wounds

作　　者：王晨[1] 罗鹏飞[1] 蒋勇[1] 何飞 伍国胜[1] 李理[1] 孙瑜[1] 贲道锋[1] WANG Chen;LUO Peng-fei;JIANG Yong;HE Fei;WU Guo-sheng;LI Li;SUN Yu;BEN Dao-feng(Department of Burn and Trauma Surgery,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院烧创伤外科,上海200433

出　　处：《第二军医大学学报》2020年第3期330-333,共4页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81171842).

摘　　要：目的探讨双蒂皮瓣在复杂软组织缺损创面修复中的应用价值。方法2014年1月至2018年12月,海军军医大学(第二军医大学)长海医院烧创伤外科对92例因肿瘤、创伤等因素导致软组织缺损的患者行双蒂皮瓣移植术,观察并记录病因、缺损部位、双蒂皮瓣的长宽比和覆盖创面的面积、供瓣区的处置方式、血管穿支的保留情况、双蒂皮瓣的成活情况、供瓣区是否需要二次手术等。结果92例患者中,引起缺损的原因包括肿瘤切除术后49例、外伤36例(骨外露17例、内固定外露12例、肌腱外露7例)、其他原因7例(压疮5例、电烧伤2例)。软组织缺损部位依次为小腿(28例)、踝(16例)、大腿(14例)、躯干(12例)、上肢(11例)、臀部(6例)、足(5例)。双蒂皮瓣的长宽比为1.2~2.8,平均覆盖创面面积为(16.55±4.83)cm×(9.88±4.20)cm。供瓣区的处置方式包括直接缝合43例、延迟缝合26例、植皮23例。9例因皮瓣转移跨度、面积或长宽比较大,在分离时保留部分肌皮血管穿支。术后21 d时,89例皮瓣完全成活,3例皮瓣边缘少许坏死,祛除坏死部分后拉拢缝合。9例供瓣区存在残余创面,行二次植皮手术。结论双蒂皮瓣具有操作简便、存活可靠、创伤较少、部分供瓣区能直接或延迟缝合的优势,在肿瘤、创伤等复杂软组织缺损创面的修复中具有良好的应用价值。Objective To explore the application value of bi-pedicle flap in the repair of complex soft-tissue-defect wounds.Methods From Jan.2014 to Dec.2018,92 patients with soft-tissue-defect caused by tumors or traumatic factors were treated with bi-pedicle flap transplantation in Burn and Trauma Surgery Department of Changhai Hospital,Naval Medical University(Second Military Medical University).The clinical and surgical data were observed and recorded,including the pathogenesis,location,ratio of length to width and covering area of the flap,management of flap donor area,preservation of perforator vessels,surviving rate of the flap,and secondary transplantation rate.Results Of the 92 patients receiving bi-pedicle flap transplantation,49 cases were caused by tumor resection,36 cases were caused by trauma(17 cases of bone exposure,12 cases of internal fixation exposure and 7 cases of tendon exposure),and 7 cases were caused by other reasons(5 cases of pressure sore and 2 cases of electric burn).The locations of tissue defects were crus(28 cases),ankle(16 cases),thigh(14 cases),trunk(12 cases),upper limb(11 cases),hip(6 cases),and foot(5 cases).The ratio of length to width of the flap was 1.2-2.8,and the average covering area was(16.55±4.83)cm×(9.88±4.20)cm.There were 43 cases of direct suture of flap donor area,26 cases of delayed suture and 23 cases of skin-graft.In nine patients,the perforating branches of the musculocutaneous vessels were preserved during the separation due to the large transfer span,area and length-width ratio of the flap.Twenty-one days after surgery,the bi-pedicle flap in 89 patients survived completely,and that in 3 cases had a little necrosis on the edge.After removing the necrotic tissues,the bi-pedicle flap was closed and sutured.In nine patients,there were residual wounds in the flap donor area,and the secondary skin grafting was performed.Conclusion The bi-pedicle flap has the advantages of simple operation,reliable survival,less trauma and direct or delayed suture of partial flap donor area

关 键 词：肿瘤切除 组织缺损 双蒂瓣 供瓣区 

分 类 号：R641[医药卫生—外科学]