游离旋髂浅动脉皮瓣联合股前外侧皮瓣修复手部大面积皮肤缺损的疗效  

Efficacy of free superficial circumflex iliac artery flap combined with anterolateral thigh flap for repairing large skin defect of the hand

作　　者：戚建武[1] 陈邵 陈川 孙斌鸿[1] 柴益铜[1] 黄剑[1] 李一[1] 杨科跃[1] 孙赫阳 陈宏[1] Qi Jianwu;Chen Shao;Chen Chuan;Sun Binhong;Chai Yitong;Huang Jian;LI Yi;Yang Keyue;Sun Heyang;Chen Hong(Department of Hand Surgery,IMingbo No.6 Hospital,Ningbo 315040,China)

机构地区：[1]宁波市第六医院手外科,315040

出　　处：《中华创伤杂志》2021年第9期805-810,共6页Chinese Journal of Trauma

基　　金：宁波市鄞州区科技局项目(2018YZQ01031);宁波市医学科技计划项目(2020Y52)。

摘　　要：目的探讨游离旋髂浅动脉皮瓣联合股前外侧皮瓣修复手部大面积皮肤缺损的临床疗效。方法采用回顾性病例系列研究分析2016年1月至2019年12月宁波市第六医院收治的9例手部大面积皮肤缺损患者临床资料,其中男7例,女2例;年龄31~63岁[(45.3±5.6)岁]。皮肤缺损面积为20 cm×15 cm~25 cm×20 cm。均联合一侧游离旋髂浅动脉皮瓣及对侧股前外侧皮瓣进行修复,供、受区均Ⅰ期缝合。观察皮瓣成活、供受区愈合及并发症情况。术后1,6及12个月,参照皮瓣晚期功能评价标准评价皮瓣功能,根据中华医学会上肢部分功能评定试用标准评价手部功能,采用温哥华瘢痕量表(VVS)评分评估供区瘢痕情况。末次随访时观察皮瓣色泽、弹性、外观及供区瘢痕情况。结果患者均获随访6~18个月[(12.5±2.3)个月]。9例联合皮瓣均成活。大腿供区术后1例出现切口裂开,经Ⅱ期缝合后愈合,余供区均Ⅰ期愈合。受区皮瓣质地及外观可。5例患者皮瓣明显臃肿,行Ⅱ期皮瓣修整术,术后皮瓣外观得到明显改善。皮瓣晚期功能和手部功能评分随术后时间逐渐提高(P<0.05)。术后12个月皮瓣晚期功能评价:优3例,良4例,可2例,优良率为78%。术后12个月手部功能评价:优3例,良3例,可3例,优良率为67%。供区VVS评分术后1个月为(9.7±1.3)分,术后6个月为(5.7±0.9)分,术后12个月为(3.4±0.8)分(P<0.05)。末次随访时皮瓣色泽弹性与周围皮肤组织接近,轻度臃肿,供区瘢痕小。结论采用游离旋髂浅动脉皮瓣联合股前外侧皮瓣进行移植,可以一次性覆盖手部大面积皮肤缺损,皮瓣外观、质地良好,术后手部外观及功能恢复良好,皮瓣供区仅留线性瘢痕。Objective To investigate the clinical effect of free superficial circumflex iliac artery flap combined with anterolateral thigh flap in repairing large skin defect of the hand.Methods A retrospective case series study was conducted to analyze the clinical data of 9 patients with large skin defect of the hand admitted to Ningbo No.6 Hospital from January 2016 to December 2019,including 7 males and 2 females,aged 31-63 years[(45.3±5.6)years].The area of skin defect reanged from 20cmXl5 cm to 25 cmx20 cm.One side of the superficial circumflex iliac artery,flap and the contralateral anterolateral thigh flap were used for repair.Both recipient and donor sites were sutured at the first stage.The ilioinguinal region and thigh donor region were sutured directly.The area of superficial circumflex iliac artery flap was from 19cmx6cm to 23 cm x10cm and that of anterolateral thigh flap was 19cmX9cm to 23 cmx8 cm.The flap survival,healing of donor and recipient area and complications were observed.At 1,6 and 12 months after operation,the function of the flap was evaluated by the late functional evaluation criteria of the flap,hand function by the upper limb functional evaluation criteria of the Chinese Medical Association,and scar condition of the donor site by Vancouver Scar Scale(VVS).At the last follow-up,the color,elasticity,appearance and scar of the donor site were observed.Results All patients were followed up for 6-18 months[(12.5±2.3)months].All flaps survived successfully.All patients achieved donor-site healing at the first stage,except that one patient experienced incision dehiscence in the thigh donor site after operation and healed after the second stage suture.The texture and appearance of the flaps were good.The flap in 5 patients was obviously bloated.Therefore,the secondary skin flap repair was selected,and the appearance was significantly improved after operation.Scores for function of the flap and the hand were improved over time(P<0.05).At 12 months after operation,the function of the flap was excellent

关 键 词：手损伤 软组织损伤 外科皮瓣 

分 类 号：R658.2[医药卫生—外科学]