皮神经营养血管皮瓣发生色素沉着的相关因素分析  

Related factors and prevention of pigmentation in cutaneous neurovascular flap

作　　者：王红涛 王辉[1] 贾鑫玮 王伟[1] 涂振兴 Wang Hongtao;Wang Hui;Jia Xinwei;Wang Wei;Tu Zhenxing(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan 063000,China;Department of Orthopedics,the Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,China)

机构地区：[1]唐山市第二医院手外科,唐山063000 [2]华北理工大学附属医院骨科,唐山063000

出　　处：《中华医学美学美容杂志》2022年第5期413-417,共5页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：河北省高层次人才资助项目(A201901124);河北省医学科学研究课题计划项目(20201453);河北省医学适用技术跟踪项目(GZ2021030)。

摘　　要：目的探讨皮神经营养血管皮瓣修复四肢皮肤软组织缺损术后发生色素沉着的危险因素。方法 2013年1月至2020年3月, 唐山市第二医院手外科收集160例(男115例、女45例;年龄20~66岁, 平均44岁)成活的四肢皮神经营养血管皮瓣患者的临床资料。根据是否出现色素沉着将其分为色素沉着组和无色素沉着组。观测指标包括性别、年龄、致伤原因、缺损面积、清创是否彻底、皮瓣静脉血管是否吻合、是否有防晒措施以及术后是否发生感染。对观测指标进行单因素分析筛选皮神经营养血管皮瓣发生色素沉着的影响因素, 用Logistic回归进行多因素分析, 筛选危险因素。结果术后患者随访12~24个月, 平均随访17.9个月, 29例(18.1%)患者皮瓣出现色素沉着。单因素分析显示, 两组在性别、年龄、致伤原因、缺损面积方面, 差异无统计学意义(P>0.05) 。多因素分析显示, 清创不彻底、皮瓣静脉血管未吻合、未做防晒措施及术后发生感染是皮神经营养血管皮瓣发生色素沉着的危险因素(OR=0.310、0.335、0.355、5.878;95%CI=0.112~0.863、0.115~0.975、0.133~0.949、2.069~16.697, 均P<0.05)。结论清创不彻底、皮瓣静脉血管未吻合、未做防晒措施及术后发生感染是影响神经营养血管皮瓣发生色素沉着的危险因素。Objective To explore the risk factors of skin flap pigmentation after repairing skin and soft tissue defects of extremities using cutaneous neurovascular flap and to give some suggestions for prevention and treatment.Methods From January 2013 to March 2020,160 cases of extremities cutaneous nerve vascular flap with survival in Tangshan Second Hospital were retrospectively studied.According to the occurrence of pigmentation,they were divided into two groups:Group A(pigmentation group)and Group B(non-pigmentation group).The observation indexes included sex,age,injury cause,defect size,complete debridement,anastomosis of skin flap,sunscreen measures and postoperative infection.First,univariate analysis was carried out to screen the influencing factors of pigmentation in the cutaneous neurovascular flap,and then Logistic regression was used for multivariate analysis to screen the risk factors.Results The postoperative follow-up time was 12 to 24 months,with an average of 17.9 months.A total of 29 patients(18.1%)had skin flap pigmentation.Univariate analysis showed that there was no significant difference in sex,age,cause of injury and defect area between the two groups(P>0.05).Further multivariate analysis showed that incomplete debridement,lack of venous anastomosis,failure to take sunscreen measures and postoperative infection were the risk factors of pigmentation of cutaneous neurovascular flap(OR=0.310,0.335,0.355、5.878,95%CI=0.112-0.863,0.115-0.975,0.133-0.949,2.069-16.697,P<0.05).Conclusions Incomplete debridement,lack of venous anastomosis,failure to take sunscreen measures and postoperative infection are the risk factors resulting in pigmentation of neurovascular flap.It is important to perform prevention to reduce the incidence of pigmentation.

关 键 词：皮肤色素沉着 皮神经营养血管皮瓣 危险因素 防治措施 

分 类 号：R622[医药卫生—整形外科]