联体穿支皮瓣游离移植修复四肢环形皮肤软组织缺损  

Application of conjoined perforator flap for repair of circular skin and soft tissue defects of limbs

作　　者：吴攀峰[1] 黄承雄 卿黎明[1] 庞晓阳[1] 周征兵[1] 俞芳[1] 曾磊[1] 潘丁[1] 肖勇兵[1] 刘睿[1] 张兴 唐举玉[1] Wu Panfeng;Huang Chengxiong;Qing Liming;Pang Xiaoyang;Zhou Zhengbing;Yu Fang;Zeng Lei;Pan Ding;Xiao Yongbing;Liu Rui;Zhang Xing;Tang Juyu(Department of Hand Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院手外科,长沙410008

出　　处：《中华手外科杂志》2021年第5期325-328,共4页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金(82072194,81901978,81871577);湖南省自然科学基金(2018JJ2640)。

摘　　要：目的探讨联体穿支皮瓣游离移植修复四肢环形皮肤软组织缺损的可行性及临床应用效果。方法自2016年3月至2019年4月收治四肢环形皮肤软组织缺损7例。术前初步测量和判断四肢环形皮肤软组织缺损的宽度及长度,根据“提捏实验”判断预选供区所能切取的皮瓣宽度,在一期闭合供区的前提下,选择最合适的供区。然后通过手持Doppler探测并标记供区合适的穿支位置。术中以布样环形包裹四肢,根据创面形状设计布样,以供区能直接闭合为原则,依据术前供区所能切取的皮瓣宽度和长度裁剪布样,化宽度为长度设计联体穿支皮瓣。皮瓣供区例为腹壁下动脉联体穿支皮瓣,6例为股前外侧联体穿支皮瓣。皮瓣切取面积25 cm×10 cm〜45 cm×10 cm。皮瓣血液循环重建方法:内增压6例,外增压联合内增压1例;内引流5例,内引流联合外引流2例。1例受区残余部分创面植皮修复。5例皮瓣供区直接闭合,2例供区残余部分创面植皮修复。结果术后7例患者皮瓣均顺利存活。1例患者受区残余创面予VAC临时覆盖加压,局部皮瓣远端少许坏死,经二期换药伤口延期愈合。所有皮瓣受区均I期愈合。全部病例随访3~36个月,平均12个月,受区外观、功能恢复满意。结论联体穿支皮瓣游离移植是修复四肢环形皮肤软组织缺损较为理想的方法,值得临床推广应用。Objective To investigate the feasibility and clinical efficacy of free transplantation of conjoined perforator flap in repairing circular skin and soft tissue defects of limbs.Methods From March 2016 to April 2019,7 cases of circular skin and soft tissue defects of limbs were treated.The width and length of the annular skin and soft tissue defect of the limbs were measured and judged preliminarily before operation.The width of the flap that can be cut from the pre selected donor area was judged according to the“lifting and kneading experiment”.On the premise of closing the donor area in one stage,the most appropriate donor area was selected.Then,the appropriate perforator position in the donor area is detected and marked by hand-held Doppler.During the operation,the limbs were wrapped with cloth samples,and the cloth samples were designed according to the shape of the wound.Based on the principle that the donor area can be closed directly,the cloth samples were cut according to the width and length of the flap that can be cut from the donor area before the operation,and the conjoined perforator flap was designed by changing the width into length.Flap donor area:1 case was the conjoined perforator flap of inferior abdominal artery,and 6 cases were the anterolateral femoral conjoined perforator flap.The area of flap was 25 cm×10 cm to 45 cm×10 cm.Blood circulation reconstruction of flap:internal pressurization in 6 cases,external pressurization combined with internal pressurization in 1 case.There were 5 cases of internal drainage and 2 cases of internal drainage combined with external drainage.The residual wound in recipient area of one case was repaired by skin grafting.The donor area of flap was closed directly in 5 cases,while skin grafting was used to repair the residual wounds in 2 cases.Results All the flaps survived successfully.In one patient,the residual wound in the recipient area was temporarily covered and pressurized by VAC,a little necrosis at the distal end of the local flap occurred,and the w

关 键 词：外科皮瓣 治疗结果 四肢环形创面 内增压 外增压 

分 类 号：R658[医药卫生—外科学]