改良技术降低远端蒂腓肠皮瓣部分坏死率的临床研究  

Clinical study of modified technique to reduce partial necrosis rate of distally pedicled sural flap

作　　者：彭平[1] 董忠根[1] 刘立宏[1] 魏建伟[1] 罗兆彪[1] 曹舒 PENG Ping;DONG Zhonggen;LIU Lihong;WEI Jianwei;LUO Zhaobiao;CAO Shu(Department of Orthopedics,the Second Xiangya Hospital,Central South University,Changsha Hunan,410001,P.R.China)

机构地区：[1]中南大学湘雅二医院骨科,长沙410001

出　　处：《中国修复重建外科杂志》2021年第6期750-755,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81672188);湖南省卫生计生委科研计划课题项目(B20180313)。

摘　　要：目的探讨针对远端蒂腓肠皮瓣部分坏死危险因素进行的多种技术改良能否降低该皮瓣部分坏死率。方法回顾分析2010年4月—2019年12月,采用改良技术设计并切取远端蒂腓肠皮瓣进行下肢远端皮肤软组织缺损修复的254例(256处)患者(改良组)临床资料,并与2001年4月—2010年3月采用传统方法设计并切取该皮瓣进行下肢远端软组织缺损修复的175例(179处)患者(对照组)进行比较。通过改良技术降低皮瓣近端位置、减小皮瓣长宽比和瓣部宽度。两组患者性别、年龄、致伤原因、受伤至手术时间、软组织缺损部位及缺损范围等一般资料比较,差异均无统计学意义(P>0.05)。测量并计算皮瓣瓣部及筋膜蒂长度、宽度,皮瓣总长及长宽比,旋转点位置;根据小腿后方9分区明确皮瓣近端位置;术后观察皮瓣部分坏死发生情况、创面成功修复率。结果两组皮瓣瓣部长度及宽度、筋膜蒂长度、皮瓣总长及长宽比以及旋转点位置比较,差异均无统计学意义(P>0.05)。改良组皮瓣筋膜蒂宽度明显大于对照组(t=–2.019,P=0.044)。对照组32处(17.88%)、改良组31处(12.11%)皮瓣近端位于第9区;改良组42.58%(109处)皮瓣长宽比超过5∶1,高于对照组42.46%(76处);改良组57.42%(147处)皮瓣瓣部宽度超过8 cm,明显低于对照组59.78%(107处);但上述指标组间差异均无统计学意义(P>0.05)。对照组术后皮瓣完全成活155处(86.59%)、部分坏死24处(13.41%),其中21处经对症处理后创面愈合、3处最终截肢;创面成功修复率为98.32%(176/179)。改良组术后皮瓣完全成活241处(94.14%)、部分坏死15处(5.86%),其中14处经对症处理后创面愈合、1处最终截肢;创面成功修复率为99.61%(255/256)。改良组皮瓣部分坏死率低于对照组,差异有统计学意义(χ^(2)=7.354,P=0.007);两组创面成功修复率差异无统计学意义(P=0.310)。两组患者均获随访,随访时间1~131个月,中位时间9.5个Objective To investigate whether the technical modifications regarding the risk factors related to the partial necrosis of the distally pedicled sural flap could reduce the partial necrosis rate of the flap. Methods A clinical data of 254 patients(256 sites)(modified group), who used modified technique to design and cut distally pedicled sural flaps to repair the distal soft tissue defects of the lower limbs between April 2010 and December 2019, was retrospectively analyzed. Between April 2001 and March 2010, 175 patients(179 sites)(control group) who used the traditional method to design and cut the skin flap to repair the distal soft tissue defects of the lower limbs were compared. Various technical modifications were used to lower the top-edge of the flap, reduce the length-width ratio(LWR) of the flap and width of the skin island. There was no significant difference in gender, age, etiology, duration from injury to operation, site and area of the soft tissue defect between groups(P>0.05). The length and width of the skin island and adipofascial pedicle, the total length of the flap and LWR, and the pivot point position were measured and recorded. The top-edge of the flap was determined according to the division of 9 zones in the posterior aspect of the lower limb. The occurrence of partial necrosis of the flap and the success rate of defect reconstruction were observed postoperatively. Results There was no significant difference in the length and width of the skin island, the length of the adipofascial pedicle, total length and LWR of the flap, and pivot point position of the flap between groups(P>0.05). The width of the adipofasical pedicle in modified group was significant higher than that in control group(t=–2.019, P=0.044). The top-edge of 32 flaps(17.88%)in control group and 31 flaps(12.11%) in modified group were located at the 9 th zone;the constituent ratio of the LWR more than 5∶1 in modified group(42.58%, 109/256) was higher than that in control group(42.46%, 76/179);and the constituent ratio of

关 键 词：远端蒂腓肠皮瓣 技术改良 皮瓣坏死 软组织缺损 并发症 

分 类 号：R658.3[医药卫生—外科学]