携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损  

Abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle

作　　者：刘安铭 周鑫 欧昌良 黄宇 黄波 罗旭超 李迦宇 邹永根 LIU Anming;ZHOU Xin;OU Changliang;HUANG Yu;HUANG Bo;LUO Xuchao;LI Jiayu;ZOU Yonggen(Department of Hand Surgery,Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou Sichuan,646000,P.R.China)

机构地区：[1]西南医科大学附属中医医院手外科,四川泸州646000

出　　处：《中国修复重建外科杂志》2021年第7期886-890,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损的临床疗效。方法2016年6月—2019年6月收治15例足踝部大面积皮肤软组织缺损患者,男10例,女5例;年龄10~60岁,平均30岁。致伤原因:交通事故伤6例,机器绞伤3例,重物砸伤3例,摔伤2例,电击伤1例。受伤至入院时间3 h~10 d,平均2 d。创面部位:足背5例,踝部6例,足背及踝部3例,足背及足底1例。创面均有不同程度污染且伴有肌腱及骨外露,其中5例足背皮肤大面积坏死伴感染。创面范围为18 cm×6 cm~25 cm×8 cm。伴有足踝部骨折及脱位9例,足踝部骨缺损2例。采用携带双侧旋髂浅动脉的腹部游离皮瓣修复创面,皮瓣切取范围为20 cm×8 cm~27 cm×10 cm;显微镜下修薄皮瓣,使其厚度为0.5~1.0 cm,平均0.7 cm。供区切口均直接缝合。结果术中1例因旋髂浅动脉较细而腹壁浅动脉较粗,改行携带腹壁浅动脉的腹部游离皮瓣修复。15例皮瓣均顺利成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合。患者均获随访,随访时间8~36个月,平均15个月。皮瓣外形满意,无明显臃肿,质地良好,不影响穿鞋,无需二次手术修薄皮瓣,仅皮瓣边缘有轻度色素沉着。供区遗留线性瘢痕,对髋关节活动无影响。伴有骨折者均愈合良好,愈合时间3~8个月,平均6个月。结论携带双侧旋髂浅动脉的腹部游离皮瓣供区较隐蔽,损伤小,可一期缝合,血管解剖恒定,变异少,血供可靠,是修复足踝部大面积皮肤软组织缺损的理想皮瓣之一。Objective To investigate the effectiveness of abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle.Methods Between June 2016 and June 2019,15 patients with large skin and soft tissue defects of foot and ankle were admitted,including 10 males and5 females with an average age of 30 years(range,10-60 years).The causes of injury included 6 cases of traffic accident,3 cases of machine strangulation,3 cases of heavy object injury,2 cases of fall,and 1 case of electric shock.The time from injury to admission was 3 hours to 10 days,with an average of 2 days.The wound located at dorsal foot in 5 cases,ankle in6 cases,dorsal foot and ankle in 3 cases,and dorsal foot and sole in 1 case.All wounds were contaminated to varying degrees and accompanied by tendon and bone exposure,including 5 cases of extensive necrosis of the dorsal skin with infection.The area of defects ranged from 18 cm×6 cm to 25 cm×8 cm.There were 9 cases of foot and ankle fractures and dislocations,and 2 cases of foot and ankle bone defects.The wound was repaired with abdominal free flap carrying bilateral superficial circumflex iliac arteries.The area of the flaps ranged from 20 cm×8 cm to 27 cm×10 cm;the skin flaps were thinned under the microscope to make the thickness of 0.5-1.0 cm,with an average of 0.7 cm.All incisions at the donor site were sutured directly.Results During the operation,1 case was replaced with an abdominal free flap carrying the superficial abdominal artery because the superficial iliac circumflex artery was thin and the superficial abdominal artery was thicker.The skin flaps of 15 cases survived smoothly,and the wounds healed by first intention;the donor incisions all healed by first intention.All patients were followed up 8-36 months,with an average of 15 months.The flap shape was satisfactory,with good texture and mild pigmentation of the flap edge,without obvious bloating,effect on shoe wear,or secondary surgical thinning of the flap.

关 键 词：足踝部 软组织缺损 旋髂浅动脉 腹部游离皮瓣 创面修复 

分 类 号：R658.3[医药卫生—外科学]