胸背动脉嵌合穿支皮瓣修复合并深部死腔的四肢皮肤软组织缺损的疗效分析  

Clinical application of a thoracodorsal artery chimeric perforator flap to repair extremity soft tissue defects complicated with a deep dead cavity

作　　者：卿黎明[1] 唐举玉[1] 吴攀峰[1] 俞芳[1] 庞晓阳[1] 潘丁[1] 肖勇兵[1] 曾磊[1] 刘睿[1] Qing Liming;Tang Juyu;Wu Panfeng;Yu Fang;Pang Xiaoyang;Pan Ding;Xiao Yongbing;Zeng Lei;Liu Rui(Department of Orthopaedics,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科,长沙410008

出　　处：《中华创伤骨科杂志》2021年第12期1076-1081,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(81901978);湖南省自然科学青年基金(2019JJ50940)。

摘　　要：目的探讨胸背动脉嵌合穿支皮瓣修复合并深部死腔的四肢皮肤软组织缺损的临床疗效。方法回顾性分析2014年7月至2019年7月期间中南大学湘雅医院骨科采用胸背动脉嵌合穿支皮瓣修复的17例合并深部死腔的四肢皮肤软组织缺损患者资料。男10例,女7例;年龄为2~39岁,平均20.2岁;致伤原因或病因:交通伤7例,慢性骨髓炎5例,重物压伤2例,肿瘤根治术后3例。损伤部位:下肢15例,上肢2例。皮肤软组织缺损面积范围:5 cm×3 cm~24 cm×9 cm。清创后创面均伴有不同程度的死腔及深部组织外露。应用胸背动脉嵌合穿支皮瓣的肌瓣部分填充深部死腔,皮瓣部分覆盖浅表创面。皮瓣供区直接缝合。术后随访患者皮瓣受区与供区恢复情况,采用手外科手术学皮瓣综合评定标准评定临床疗效。结果术后仅1例患者皮瓣远端发生部分坏死,经换药后愈合;其余16例患者的皮瓣均顺利存活,皮瓣受区与供区均一期愈合。1例患者发生静脉危象,经血管危象探查后顺利存活。17例患者术后获6~24个月(平均15.8个月)随访。所有患者的皮瓣颜色、质地及弹性均好,无明显臃肿。末次随访时根据手外科手术学皮瓣综合评定标准评定疗效:优10例,良6例,可1例。皮瓣供区仅留线性瘢痕,肩关节外展功能无影响。结论胸背动脉嵌合穿支皮瓣只需吻合一组血管蒂,就能同时修复深部死腔和体表创面,疗效良好,是一种修复合并深部死腔的四肢皮肤软组织缺损的较理想方法。Objective To explore the curative effects of thoracodorsal artery chimeric perforator flap used to repair extremity soft tissue defects complicated with a deep dead cavity.Methods From July 2014 to July 2019,17 patients with extremity soft tissue defects complicated with a deep dead cavity were repaired by a thoracodorsal artery chimeric perforator flap at Department of Orthopaedics,Xiangya Hospital.They were 10 males and 7 females,aged from 2 to 39 years(mean,20.2 years).There were 7 cases of traffic accident trauma,5 ones of chronic osteomyelitis,2 ones of crushing injury and 3 ones of radical resection of tumor.The defects were located at the lower extremity in 15 cases and at the upper extremity in 2.The wound sizes ranged from 5 cm×3 cm to 24 cm×9 cm.All the wounds were complicated somewhat with a dead cavity or exposure of deep tissues after debridement.The muscular component of thoracodorsal artery chimeric perforator flap was used to fill the dead cavity while the skin component to cover the superficial wounds.The flap donor sites were closed directly.The flap survival and donor site recovery were followed up regularly after operation.The curative effects were assessed according to the comprehensive evaluation criteria of hand surgery for flaps.Results Necrosis of the distal flap occurred in only one case which responded to dressing change;the flaps survived uneventfully in the other 16 cases.The recipient and donor sites of flaps healed primarily in all patients.Venous crisis developed in one case which survived uneventfully after vascular crisis exploration.The 17 patients were followed up for 6 to 24 months(mean,15.8 months).In all patients the flap presented with good color,texture and elasticity but without obvious swelling.At the last follow-up,the curative effects by the comprehensive evaluation criteria of hand surgery for flaps were excellent in 10 cases,good in 6 and fair in one.Only linear scar remained at the flap donor site and abduction of the shoulder was not affected.Conclusion The thora

关 键 词：穿支皮瓣 四肢 软组织缺损 胸背动脉 显微外科技术 

分 类 号：R658[医药卫生—外科学]