股薄肌肌皮瓣修复开放性骨盆骨折时会阴部软组织缺损  

Gracilis musculocutaneous flap in repair of perineal soft tissue defect with open pelvic fracture

作　　者：焦健 张朝 刘重 石宇 牛峰 高方 马宁 滕云升 郭永明 JIAO Jian;ZHANG Zhao;LIU Zhong;SHI Yu;NIU Feng;GAO Fang;MA Ning;TENG Yunsheng;GUO Yongming(Department of Trauma and Orthopaedic,521 Hospital of Norinco Group,Institute of Hand Microsurgery of Shanxi Province,Xi’an 710065,China)

机构地区：[1]兵器工业521医院创伤骨科,陕西手显微外科研究所,西安710065

出　　处：《中华显微外科杂志》2022年第4期418-421,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨股薄肌肌皮瓣修复开放性骨盆骨折时会阴部软组织缺损的临床疗效。方法 2009年6月至2019年6月, 兵器工业521医院创伤骨科收治11例伴有会阴部软组织缺损的开放性骨盆骨折患者, 其中男4例, 女7例;年龄16~56岁, 平均33岁。致伤原因:交通伤6例, 高处坠落伤4例, 重物砸伤1例。患者均为开放性骨盆骨折, 按照Tile分型标准:A型1例,B型7例,C型3例。均伴有会阴部软组织损伤, 缺损创面范围为5 cm×5 cm~8 cm×12 cm。以股薄肌肌皮瓣修复缺损创面, 皮瓣切取范围为6 cm×5 cm~9 cm×13 cm。皮瓣供区均直接缝合。术后加强营养支持, 保持平卧位避免外展, 适当抬高下肢。并定期随访。结果 11例均获随访, 随访时间6~30个月, 平均22个月。11例肌皮瓣均成活, 其中1例肌皮瓣远端表面皮肤少许坏死, 经换药后创面愈合。供区切口均Ⅰ期愈合。股薄肌肌皮瓣质地、颜色、弹性良好, 供瓣区有瘢痕存在, 但无明显功能障碍, 随访期间供区及受区无破溃发生。患者对外观及功能均满意。结论股薄肌肌皮瓣是修复开放性骨盆骨折时会阴部软组织缺损的一种较理想术式。Objective To investigate the clinical effect of gracilis musculocutaneous flap in repair of perineal soft defect with open pelvic fracture.Methods From June 2009 to June 2019,11 cases of open pelvic fracture associated with perineal injury were treated in the Department of Trauma and Orthopaedic of 521 Hospital of Norinco Group.There were 4 males and 7 females aged 16-56(33 in average)years old.Cause of injuries:6 cases by traffic accident,4 by falling from height,and 1 by crushing.All the patients had open pelvic fractures.According to Tile classification,1 case was rated as type A,7 as type B and 3 as type C.All the patients were accompanied with perineal injury and soft tissue defect.The wound sizes ranged from 5 cm×5 cm to 8 cm×12 cm.The defects were repaired with gracilis musculocutaneous flap.The size of gracilis myocutaneous flaps was 6 cm×5 cm to 9 cm×13 cm.All donor areas of the flap were sutured directly.After surgery,11 patients treated with strengthened nutritional support,keep supine position to avoid abduction,and appropriately raise the lower limbs.Follow-ups were conducted regularly after surgery.Results All patients entered 6 to 30(22 in average)months of follow-up.All of 11 myocutaneous flaps survived,besides 1 had a few necrosis at the distal surface of the myocutaneous flap,and healed after change of dressing.All the incisions at donor site had stage I healing.The colour,texture and flexibility of the gracilis myocutaneous flap were good.There was a scar at the donor sites without causing obvious dysfunction.Over the follow-up period,there was no failure of flap in either the recipient and donor sites.The patients were satisfied with the appearance and function.Conclusion Gracilis musculocutaneous flap is one of the ideal methods in repair of perineal soft tissue defect with open pelvic fracture.

关 键 词：股薄肌肌皮瓣 会阴部 开放性骨盆骨折 组织修复 

分 类 号：R683.3[医药卫生—骨科学]