游离修薄腹壁下动脉穿支皮瓣修复四肢大面积软组织缺损的临床效果  

Clinical effects of free thinned deep inferior epigastric artery perforator flap in repairing extensive soft tissue defects in extremities

作　　者：刘洋[1,4] 宋达疆 谢松林[3] 宋涛[1] 张文韬[1] 田小宁[1] 从飞[1] 杜晓龙[1] 陈勋[1] 范金柱[1] 郝定均[1] Liu Yang;Song Dajiang;Xie Songlin;Song Tao;Zhang Wentao;Tian Xiaoning;Cong Fei;Du Xiaolong;Chen Xun;Fan Jinzhu;Hao Dingjun(Medical Department of Xi′an Jiaotong University,Xi′an 710000,China;Department of Oncology Plastic Surgery,Hunan Province Cancer Hospital,Changsha 410008,China;Department of Hand and Foot Surgery,Affiliated Nanhua Hospital,University of South China,Hengyang 421001,China;Department of Bone Microsurgery,Xi′an Honghui hospital,Xi′an 710054,China)

机构地区：[1]西安交通大学医学部,710000 [2]湖南省肿瘤医院肿瘤整形外科,长沙410008 [3]南华大学附属南华医院手足外科,衡阳421001 [4]西安市红会医院显微修复外科,710054

出　　处：《中华烧伤杂志》2020年第7期590-593,共4页Chinese Journal of Burns

基　　金：湖南省自然科学基金面上项目(2018JJ2241、2018JJ2242);湖南省肿瘤整形外科临床医学研究中心平台建设专项(2013TP4087);湖南省科卫联合项目(2018JJ6028);湖南省卫生健康委员会课题(B2019092);长沙市科技计划基础研究项目(kq1901074、kq1901077)。

摘　　要：目的探讨采用游离修薄腹壁下动脉穿支皮瓣修复四肢大面积软组织缺损的可行性和临床疗效。方法2010年4月—2014年1月,西安市红会医院显微修复外科收治12例外伤致四肢大面积软组织缺损患者,其中男10例、女2例,年龄21~48岁,6例为腕背部缺损、6例为足踝部缺损。清创后软组织缺损面积为15.0 cm×4.5 cm^28.0 cm×11.0 cm,设计切取修薄腹壁下动脉穿支皮瓣游离移植修复,皮瓣切取面积为15.0 cm×5.0 cm^29.0 cm×12.0 cm,修薄之前皮瓣厚度为4.0~6.5 cm,修薄之后皮瓣厚度为0.6~0.9 cm。所有皮瓣供区直接拉拢缝合。观察皮瓣成活情况,随访皮瓣和供区外观功能情况。结果术后所有患者皮瓣均顺利成活。随访10~42个月,患者皮瓣外形不臃肿,无须Ⅱ期修薄,两点辨别觉距离为11~17 mm,平均14.5 mm。患者腹壁功能未受明显影响,未见腹壁疝或溃疡发生。结论游离修薄腹壁下动脉穿支皮瓣质地薄,适合修复四肢大面积软组织缺损且效果较佳。Objective To explore the feasibility and clinical effects of using free thinned deep inferior epigastric artery perforator flap to repair extensive soft tissue defects in extremities.Methods From April 2010 to January 2014,12 patients with extensive soft tissue defect in extremities after trauma,including 10 males and 2 females,aged 21 to 48 years,6 patients with defect in the back of wrist and 6 patients with defect in ankle were admitted to the Department of Bone Microsurgery of Xi′an Honghui hospital.After debridement,the size of soft tissue defect ranged from 15.0 cm×4.5 cm to 28.0 cm×11.0 cm.The free thinned deep inferior epigastric artery perforator flap was designed,cut and transferred for reconstruction,with size of 15.0 cm×5.0 cm to 29.0 cm×12.0 cm.The flap thickness ranged from 4.0 to 6.5 cm before defatting,and was 0.6 to 0.9 cm after defatting.All the donor sites of flaps were closed directly by suturing.The flap survival and the appearance and function of flap and donor site were observed during follow-up.Results All the flaps survived smoothly after surgery.During follow-up of 10 to 42 months,the flaps showed no bloat in appearance,no further flap revision or defatting procedures were required,the distance of static 2-point discrimination was 11 to 17 mm(14.5 mm on average).The abdominal function of patients was not affected,and no postoperative abdomen hernia or ulceration was noted.Conclusions The free thinned deep inferior epigastric artery perforator flap is thin and suitable for repairing extensive soft tissue defects in extremities with very good outcomes.

关 键 词：外科皮瓣 显微外科手术 四肢 软组织损伤 

分 类 号：R64[医药卫生—外科学] R622+.1[医药卫生—临床医学]