拱顶石皮瓣在修复下肢软组织缺损中的应用  

Application of Keystone flap in the repair of soft tissue defect of lower extremity

作　　者：阿尔肯·居曼 买买艾力·玉山 阿不来提·阿不拉[1] 任鹏[1] 程二林 艾合买提江·玉素甫[1] Aerken·Juman;Maimaiaili·Yushan;Abulaiti·Abula;REN Peng;CHENG Erlin;Aihemaitijiang·Yusufu(Department of Microreconstructive Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang,830011,P.R.China)

机构地区：[1]新疆医科大学第一附属医院显微修复外科,乌鲁木齐830011

出　　处：《中国修复重建外科杂志》2021年第8期1038-1042,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨拱顶石皮瓣修复下肢软组织缺损的效果。方法回顾分析2018年1月—2020年6月应用拱顶石皮瓣修复的27例下肢软组织缺损患者临床资料。其中男18例,女9例;年龄8~63岁,平均43.9岁。软组织缺损原因:肿瘤3例,溃疡2例,感染8例,创伤7例,游离或带蒂皮瓣修复术后供区缺损7例。软组织缺损范围为2.0 cm×1.5 cm~15.0 cm×9.5 cm。应用拱顶石皮瓣类型为Ⅰ型2例、Ⅱa型16例、Ⅱb型1例、Ⅲ型6例、Moncrieff改良型2例。皮瓣切取范围为3.0 cm×1.5 cm~20.0 cm×10.0 cm。26例供区直接缝合,1例游离植皮修复。结果手术时间45~100 min,平均67.5 min;住院时间3~12 d,平均8.5 d。术后发生切口裂开1例、皮瓣边缘部分坏死2例,均经换药后完全愈合;1例切口肿胀充血,出现张力性水疱,术后7 d自行消退。其余患者皮瓣及植皮均成活,受区及供区创面Ⅰ期愈合,愈合时间2~3周,平均2.2周。所有患者均无疼痛发生。27例均获随访,随访时间3~26个月,平均11.5个月。未见明显瘢痕挛缩、皮瓣臃肿,受区皮肤质地、颜色与周围组织相近,感觉存在。结论拱顶石皮瓣修复下肢软组织缺损操作简便,愈合后皮瓣颜色、质地与周围皮肤相似,是一种有效治疗方法。Objective To study the effectiveness of Keystone flap in the repair of soft tissue defect of lower extremity.Methods The clinical data of 27 cases with soft tissue defects of lower extremity treated by Keystone flap between January 2018 and June 2020 were retrospectively analyzed.There were 18 males and 9 females,with an average age of 43.9 years(range,8-63 years).The cause of soft tissue defects included skin tumor in 3 cases,ulcer in 2 cases,softtissue infection in 8 cases,trauma in 7 cases,and donor site defect after free or pedicled flap transplantation in 7 cases.Defect size ranged from 2.0 cm×1.5 cm to 15.0 cm×9.5 cm.The types of Keystone flaps included typeⅠin 2 cases,typeⅡa in 16 cases,typeⅡb in 1 case,typeⅢin 6 cases,and Moncrieff modified type in 2 cases.The area of flap ranged from3.0 cm×1.5 cm to 20.0 cm×10.0 cm.The donor site was directly sutured(26 cases)or repaired with skin grafting(1 case).Results The operation time was 45-100 minutes,with an average of 67.5 minutes;the hospitalization stay was 3-12 days,with an average of 8.5 days.Postoperative incision dehiscence occurred in 1 case,and flap marginal necrosis occurred in2 cases,all of which were completely healed after dressing change;1 case of incision was swollen and congested with tension blisters,which resolved spontaneously at 7 days after operation.The other flaps and the skin grafting survived and healed successfully,the wounds of recipient and donor sites healed by first intention.The healing time was 2-3 weeks(mean,2.2 weeks).No pain occurred in all patients.All 27 cases were followed up 3-26 months(mean,11.5 months).No obvious scar contracture and bloated skin flap were found.The texture and color of the skin in the recipient area were similar to those of the surrounding tissues and feel existed.Conclusion The Keystone flap is a feasible and efficient way to repair soft tissue defect of lower extremity.Furthermore,the skin color and texture is similar to the surrounding tissue after healing.

关 键 词：拱顶石皮瓣 显微外科技术 软组织缺损 下肢 

分 类 号：R658.3[医药卫生—外科学]