14例皮瓣修复创面失败的原因分析及防治对策  

Cause analysis and countermeasure discussion of failure in 14 cases who underwent wound repair

作　　者：向湘华 黄阿勇 黄秋萍 庄智勇 蔡金表 王道明 XIANG Xianghua;HUANG Ayong;HUANG Qiuping(Department of Hand Surgery,Quanzhou Orthopedic-Traumatological Hospital of Fujian Province,Quanzhou,Fujian,362000,China)

机构地区：[1]福建省泉州市正骨医院手外科,福建泉州362000 [2]福建省泉州市正骨医院药剂科,福建泉州362000

出　　处：《实用手外科杂志》2022年第1期73-76,94,共5页Journal of Practical Hand Surgery

摘　　要：目的分析14例伴有骨质、肌腱、钢板等外露的创面采用皮瓣修复失败的原因,探讨防治对策。方法2020年1月-2021年1月采用皮瓣修复的有骨质、肌腱、钢板外露的创面,选取其中失败病例共14例进行回顾分析。其中腹部带蒂皮瓣3例、内踝上皮支皮瓣3例、腓肠神经营养血管皮瓣2例、指动脉皮瓣2例、骨间背动脉逆行岛状皮瓣1例、指背皮支皮瓣1例、第2掌背动脉皮瓣1例、游离腕横纹皮瓣1例,分析其失败的原因及探讨防治的方法。结果失败原因考虑术者对皮瓣理解不够1例,皮瓣选择不合适1例,创面清创不彻底1例,皮瓣面积过小1例,皮瓣外形不合理1例,设计不合理3例,术中切取原因1例,缝合原因3例,术后处理不及时、不充分2例。结论伴有骨质、肌腱、钢板外露的创面采用皮瓣修复需要术者对皮瓣供血系统有较深入的了解,有丰富的经验,能选择合适的皮瓣修复适合的创面;术中需要彻底清创、止血;皮瓣的面积、外形、长宽比要合理;设计皮瓣与创面的方向要合适,不能扭转、反折;术中皮瓣切取要细心、耐心、小心;严格遵守微创、无污染、无张力、无扭转、无死腔等原则;术后出现血运方面问题处理要及时、充分。Objective To analyze the cases in 14 cases who underwent wound repair with skin flap,accompanied by exposed bone,tendon and steel plate,and explore the prevention and treatment countermeasures.Methods Fourteen failed cases with wounds such as exposed bone,tendon and steel plate who underwent skin flap repair from January 2020 to January 2021 in the Department of Hand Surgery,Quanzhou Orthopedic-Traumatological Hospital were reviewed and selected for analysis.There were 3 cases with abdominal pedicled flap,3 cases with flaps based medial supramalleolar branches,2 cases with sural neurocutaneous flap,2 cases with digital artery flap,1 case with interosseous dorsal antidromic artery issular flap,1 case with dorsal digital cutaneous branch flap,1 case with second dorsal metatarsal artery flap and 1 free wrist transverse skin flap.The causes of their failure were analyzed and the prevention methods were discussed.Results The reasons for failure were as follows:under-interpretation of operator for the flap(1 case);improper flap selection(1 case);incomplete wound debridement(1 case);too small flap area(1 case);unreasonable flap shape(1 case);unreasonable flap design(3 cases);intraoperative excision reason(1 case);flap suture reason(3 cases);untimely and inadequate postoperative management(2 cases).Conclusion When flap is used to repair wounds with exposed bone,tendon and plate,it is necessary for the operator to have a deep understanding for the blood supply system of the flap,as well as rich experience,and choose the appropriate flap to repair the suitable wound;thorough debridement and hemostasis are needed during operation;the area,shape and length-width ratio of the flap should be reasonable;the direction of flap design and wound surface should be appropriate,and it can not be reversed or folded back;intraoperative flap cutting should be careful,patient and careful;the principles of minimally invasive,pollution-free,tension-free,torsion-free and dead space-free shall be strictly observed;postoperative blood supply p

关 键 词：皮支皮瓣 缺损 创面修复 内踝上 指动脉 游离皮瓣 

分 类 号：R658.2[医药卫生—外科学]