应用超引流技术的腓动脉穿支皮瓣修复四肢皮肤缺损  

Repair of skin defects of extremities with peroneal artery perforator flap with super-draining techniques

作　　者：袁野 邱俊涛 李辉 易芳林 李高辉 余振涛 姚刘永 路闯 Yuan Ye;Qiu Juntao;Li Hui;Yi Fanglin;Li Gaohui;Yu Zhentao;Yao Liuyong;Lu Chuang(Department of Microsurgery,the 990th Hospital of PLA Joint Logistic Support Force,Zhumadian 463000,China)

机构地区：[1]解放军联勤保障部队第990医院显微外科,驻马店463000

出　　处：《中华整形外科杂志》2021年第5期534-540,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探讨超引流技术腓动脉穿支皮瓣修复四肢皮肤缺损的临床效果。方法分析2014年3月至2019年8月解放军联勤保障部队第990医院收治的四肢创面的病例。均采用超引流技术腓动脉穿支皮瓣进行修复。术中皮瓣除常规吻合皮神经并按1∶2的动、静脉比例吻合穿支血管外,再根据皮瓣浅静脉(v)和受区浅静脉(V)在皮缘的相对位置、管径大小及静脉的长度给予匹配,按照静脉标记编号依次吻合1~3条浅静脉。上肢创面采用中华医学会手外科学分会上肢部分功能评定试用标准评定,下肢创面患者采用美国骨科足踝外科协会踝-后足评分系统评价,所有患者皮瓣感觉采用英国医学研究会感觉功能评定标准评定。结果共纳入67例,男54例,女13例,年龄21~65岁,平均44岁。创面位于上肢16例,下肢51例。术中吻合3条浅静脉的皮瓣有8例,吻合2条的皮瓣38例,吻合1条的皮瓣21例;56例直接闭合供区,11例因切取面积较大行全厚皮片移植覆盖供区。术后1例出现动脉危象,急诊探查后1/2皮瓣坏死,二期行植皮手术修复;3例出现皮瓣下积血,经清创后二期愈合;其余病例均一期愈合。随访6~44个月,术后早期未见明显肿胀及水泡,皮瓣质地与受区皮肤基本一致,后期萎缩不明显,未见色素沉着,感觉恢复较快,切口瘢痕不明显;皮瓣供区均一期愈合,无功能异常。16例上肢创面患者经中华医学会手外科学分会上肢部分功能评定试用标准评定,优12例,良3例,可1例;51例下肢创面患者经美国骨科足踝外科协会踝-后足评分系统评价,优38例,良11例,可2例;所有患者经英国医学研究会感觉功能评定标准评定,皮瓣两点辨距觉为8~10 mm,平均9.1 mm,皮瓣感觉功能48例达S3+,19例为S3。结论腓动脉穿支皮瓣手术中应用超引流技术,能有效预防皮瓣血液淤滞,降低皮瓣坏死风险,减少并发症,提高皮瓣成活质量,利于受区功能恢复。Objective To evaluate the clinical effect of applying peroneal artery perforator flap with super-draining techniques in repairing skin defects of extremities.Methods The data of patients with limb wounds admitted to the 990th Hospital of the Joint Logistics Support Force of the People’s Liberation Army from March 2014 to August 2019 were analyzed retrospectively.All were repaired with peroneal artery perforator flaps with super-draining techniques.Cutaneous nerves and perforating vessels were anastomosed according to the routine ratio of 1∶2.The superficial vein and the recipient veinwere matched and marked according to the relative position the diameter and length.Then one to three superficial veins were anastomosed in sequence according to the vein mark number.Upper limb wounds were evaluated by the trial standard of upper limb function evaluation of the Hand Surgery Branch of the Chinese Medical Association.Patients with lower limb wounds were evaluated by the American Orthopaedic Foot and Ankle Surgery Association Ankle-Hindfoot Score System.All patients were evaluated according to the sensory function evaluation standard of the British Medical Research Association.Results A total of 67 cases were included in this cohort.There were 54 males and 13 females,aged from 21 to 65 years,with an average of 44 years.Eight cases were anastomosed with three superficial veins,38 cases were anastomosed with two flaps,and 21 cases were anastomosed with one flap.The donor sites were closed directly in 56 cases.Eleven cases received full-thickness skin grafting to cover the donor site.One case showed necrosis of the half flap for the arterial crisis.The wound was repaired by full-thickness skin grafting in further treatment.Three cases had hemorrhage under the free flap,which was healed secondarily after debridement.The remaining were healed well.All patients were followed for 6 to 44 months.There was no obvious swelling and blisters in the early postoperative period.The texture of the flap was the same as the surroundin

关 键 词：穿支皮瓣 游离组织瓣 四肢 显微外科手术 血管 

分 类 号：R658[医药卫生—外科学]