自由穿支血管组合皮瓣修复腹股沟及邻近部位恶性肿瘤扩大切除后皮肤软组织缺损  

The application of jigsaw puzzle flap based on free-style perforator to repair the defect on the groin and adjacent organs after tumor extended resection

作　　者：余道江 安璐 陆蒋惠文 陈晓明 王玉龙 苏文星 Yu Daojiang;An Lu;Lu Jianghuiwen;Chen Xiaoming;Wang Yulong;Su Wenxing(Department of Plastic and Burn Surgery,the Second Affiliated Hospital of Chengdu Medical College,Chengdu 610051,China;Transformation Center of Radiological Medicine,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Plastic and Burn Surgery,the Jining People’s Hospital,Jining 272000,China)

机构地区：[1]成都医学院第二附属医院整形外科,成都610051 [2]苏州大学附属第二医院放射医学转化中心,苏州215004 [3]济宁市人民医院整形烧伤科,济宁272000

出　　处：《中华整形外科杂志》2022年第2期169-175,共7页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(32071238);四川省科技计划项目(20YYJC0034);江苏省卫计委医学青年人才项目(QNRC-960);苏州市重点卫生人才培养项目(GSWS2019013)。

摘　　要：目的探讨自由穿支血管组合皮瓣在腹股沟及邻近部位肿瘤扩大切除后皮肤软组织缺损修复中的应用价值。方法回顾性分析2013年12月至2019年8月成都医学院第二附属医院收治的行腹股沟及邻近部位软组织缺损修复术患者的临床资料。术前预判缺损面积或体积,用便携式多普勒血流探测仪探测腹股沟周边潜在供区的所有穿支血管,根据穿支血管位置、多普勒血流回声强度、单个自由式穿支血管营养的皮瓣安全面积,并需满足供区可直接拉拢缝合的要求,将大范围的缺损划分为数个较小的组成部分,而每个组成部分对应一个自由式穿支皮瓣;逆向分离自由式穿支血管,形成以穿支血管为蒂的V-Y推进、旋转、螺旋桨等形式的小面积皮瓣(可根据实际解剖的穿支血管情况修正皮瓣);所有皮瓣转移至缺损处,按术前设计(胶片模拟)重新组合,修复腹股沟及邻近器官肿瘤扩大切除后的较大创面或较深腔隙,同时供区直接拉拢缝合。术后前3 d观察皮瓣的颜色、温度、毛细血管反应,后期随访观察修复后外形及功能。结果共纳入31例患者,男18例,女13例;年龄48~82岁,平均66岁。皮肤软组织缺损面积:8.0 cm×10.0 cm~15.5 cm×20.0 cm,平均12.0 cm×15.0 cm。共切取65个皮瓣,螺旋桨皮瓣32个、旋转皮瓣18个、V-Y推进皮瓣15个;3个皮瓣组合者3例,2个皮瓣组合者28例。皮瓣切取面积:5.0 cm×10.0 cm~12.0 cm×20.0 cm,平均8.0 cm×13.0 cm,皮瓣蒂部穿支血管直径0.5 mm~4.0 mm。术后3 d皮瓣的颜色、温度、毛细血管反应正常;1例皮瓣淤血,切口愈合不良,换药处理,2周后愈合,其余30例皮瓣均一期成活。术后随访3个月至5年,平均1.5年,外形及功能良好。结论自由穿支血管皮瓣组合,可以修复腹股沟及邻近部位恶性肿瘤扩大切除后较大面积的皮肤软组织缺损,供瓣区可以直接缝合;该方法操作简便,避免了显微吻合及植皮,是一种可供Objective To investigate the application value of jigsaw puzzle flap based on free-style perforator in repairing the defect on groin and adjacent organ after tumor extended resection.Methods From December 2013 to August 2019,the data was focused on the patients who underwent soft tissue defect repair of groin and adjacent areas in the Second Affiliated Hospital of Chengdu Medical College.After the defect was predetermined preoperatively,portable ultrasound Doppler was used to map multiple perforators adjacent to the defect.The large defect was divided into several small parts,based on the location of perforators,the intensity of the Doppler,the safety size of flap that can be perfused by a single free-style perforator,and the donor sites can be closed primarily.Each component part corresponds to a free-style perforator flap.The perforator vessels were reversely dissected,and small flaps of V-Y advancement,rotation and propeller pedicled with perforator vessels were formed(appropriate modification of flaps can be made according to actual anatomical perforator vessels).All flaps were transferred to the defect site and reassembled according to the preoperative design(film simulation)to repair the large wound or deep space after the extended resection of the tumor in the groin and adjacent organs.Meanwhile,the donor site was closed and sutured primarily.The color,temperature,capillary reaction of the skin flap were observed during the first 3 days after procedure,and appearance and function after repair were observed after long-term follow-up.Results A total of 31 patients were enrolled,including 18 males and 13 females.The ages of the patients ranged from 48 to 82 years with an average of 66 years.The defect area of skin and soft tissue was 8.0 cm×10.0 cm-15.5 cm×20.0 cm,with an average of 12.0 cm×15.0 cm.A total of 65 flaps were harvested,including 32 propeller flaps,18 rotating flaps and 15 V-Y advancement flaps.There were 3 cases with 3 flaps and 28 cases with 2 flaps.The average skin flap area was 12.0 cm×20

关 键 词：外科皮瓣 恶性肿瘤 腹股沟部 缺损 修复 穿支皮瓣 

分 类 号：R730.56[医药卫生—肿瘤]