颈横动脉颈段皮支皮瓣修复颈部放射性溃疡的临床效果  

Clinical effects of flaps with cervical cutaneous branch of transverse cervical artery in repairing neck radiation ulcers

作　　者：李罡[1] 张志[1] 李叶扬[1] 汪锦伦[1] Li Gang;Zhang Zhi;Li Yeyang;Wang Jinlun(Department of Burns and Plastic Surgery,Guangzhou Red Cross Hospital,Jinan University,Guangzhou 510220,China)

机构地区：[1]暨南大学附属广州红十字会医院烧伤整形科,510220

出　　处：《中华烧伤杂志》2021年第12期1116-1121,共6页Chinese Journal of Burns

基　　金：广州市科技计划(202102010046)。

摘　　要：目的探讨应用颈横动脉颈段皮支皮瓣修复颈部放射性溃疡的临床效果。方法采用回顾性观察性研究方法。2016年1月—2019年12月,暨南大学附属广州红十字会医院采用颈横动脉颈段皮支皮瓣修复颈部放射性溃疡患者8例,其中男6例、女2例,年龄52~75岁。溃疡发生距放射治疗平均14.5年,入院时溃疡面积为5.0 cm×3.0 cm~7.0 cm×6.0 cm。切除溃疡及周围纤维化组织后创面面积为6.0 cm×5.0 cm~13.0 cm×6.5 cm。7例患者Ⅰ期行皮瓣切取、创面修复术;另1例患者Ⅰ期行皮瓣供区预扩张,Ⅱ期行皮瓣切取、创面修复术。皮瓣面积为8.0 cm×7.0 cm~15.0 cm×8.5 cm。7例患者皮瓣供区创面直接缝合;1例患者皮瓣供区创面部分缝合后,取自体大腿薄中厚皮修复。术前取溃疡组织行病理学检查,观察术后皮瓣成活情况和皮瓣供区愈合情况,随访时观察皮瓣情况、颈部溃疡复发及功能情况、皮瓣供区瘢痕增生情况。结果术前溃疡组织病理学检查显示,溃疡全层皮肤坏死,溃疡基底及周围有明显纤维组织增生、胶原化、小灶钙化;间质有大量慢性炎症细胞及少量急性炎症细胞浸润,排除肿瘤复发。8例患者术后皮瓣均成活,创面得到有效修复,皮瓣供区愈合良好。术后随访6~24个月,皮瓣外观良好,溃疡无复发,颈部活动功能得到明显改善,皮瓣供区未见明显瘢痕增生。结论颈部放射性溃疡是颈部放射治疗后较严重的远期并发症,保守治疗难以愈合。颈横动脉颈段皮支皮瓣靠近颈部,血运丰富、解剖恒定、易于切取,治疗颈部放射性溃疡后创面愈合良好,无明显瘢痕增生,功能明显改善。Objective To explore the clinical effects of flaps with cervical cutaneous branch of transverse cervical artery in repairing neck radiation ulcer.Methods The retrospective observational research was conducted.From January 2016 to December 2019,8 cases with neck radiation ulcer were admitted to Guangzhou Red Cross Hospital of Jinan University and repaired with flaps based on cervical cutaneous branch of transverse cervical artery.There were 6 males and 2 females,aged 52-75 years.The ulcers occurred 14.5 years after radiotherapy on average,with ulcer areas of 5.0 cm×3.0 cm-7.0 cm×6.0 cm on admission.The wound areas were ranged from 6.0 cm×5.0 cm to 13.0 cm×6.5 cm after ulcers and fibrotic tissue around were resected.Seven cases underwent resection of flaps and wound repair operation on the first stage,and the other 1 case underwent pre-expansion of flap donor area on the first stage and resection of flap and wound repair operation on the second stage,with flap sizes of 8.0 cm×7.0 cm-15.0 cm×8.5 cm.The wounds in the donor areas of flaps in 7 patients were sutured directly,and the wound in the donor area of flap in the other 1 patient was repaired with thin split-thickness skin graft from thigh after being sutured partially.The preoperative ulcer tissue was collected for pathological examination,and the postoperative survival of the flaps and healing of the flap donor areas were observed.The flaps,the recurrence of the neck ulcers and neck function,and the scar hyperplasia in the donor areas of flaps were observed during follow-up.Results Preoperative pathological examination of ulcer tissue showed that full-thickness necrosis occurred in ulcer skin,obvious fibrotic tissue hyperplasia,collagenization,and small-scale calcification in the base and surrounding tissue of the ulcers,and a large amount of chronic inflammatory cells and a small amount of acute inflammatory cells infiltration were observed in intercellular substance,which excluded the recurrence of tumor.All the flaps in 8 cases survived,the wounds wer

关 键 词：伤口愈合 外科皮瓣 放射性溃疡 颈横动脉颈段皮支皮瓣 

分 类 号：R605[医药卫生—外科学] R608[医药卫生—临床医学]