胸脐皮瓣联合腹部随意皮瓣修复儿童小腿大面积软组织缺损  

Thoracoumbilical flap combined with random abdominal flap in repair of large-area soft tissue defects of calf in children

作　　者：郑浩[1] 刘勇 王丽丽[2] 王剑利 高学建 ZHENG Hao;LIU Yong;WANG Lili;WANG Jianli;GAO Xuejian(Department of Surgery,Weifang Medical University,Weifang,Shandong Province 261053,China;Trauma Surgery,Affiliated Hospital of Weifang Medical University,Weifang,Shandong Province 261035,China;PLA Trauma Orthopaedic Research Institute,80th Group Military Hospital of the PLA,Weifang,Shandong Province 266033,China)

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261053 [2]潍坊医学院附属医院创伤外科,山东潍坊261035 [3]解放军第八十集团军医院全军创伤骨科研究所,山东潍坊266033

出　　处：《中华显微外科杂志》2022年第5期528-533,共6页Chinese Journal of Microsurgery

摘　　要：目的探讨胸脐皮瓣联合腹部随意皮瓣修复儿童小腿大面积软组织缺损的临床效果。方法回顾分析解放军第八十集团军医院全军创伤骨科研究所2004年1月至2007年12月采用胸脐皮瓣联合腹部随意皮瓣治疗的16例小腿大面积软组织缺损患儿的临床资料。男孩7例,女孩9例;年龄8~14岁,平均11.3岁。其中重物砸压伤6例,车轮碾挫伤6例,热压伤3例,机器绞伤1例。术中彻底清创后,创面面积为16.0 cm×9.0 cm~38.0 cm×15.0 cm。伤后3~10 h,急诊行皮瓣修复4例;入院后0~11 d,待创面稳定后手术12例。根据创面位置、大小和形状,采用彩色超声多普勒定位穿支血管情况,设计并切取胸脐皮瓣联合腹部随意皮瓣修复创面,皮瓣切取范围为18.0 cm×11.0 cm~40.0 cm×16.0 cm。术后采用门诊结合微信随访,观察记录皮瓣的外观、质地及肢体恢复情况。结果术后16例皮瓣成活,其中12例创面Ⅰ期愈合,3例皮瓣边缘出现小面积坏死,经多次换药后愈合;1例皮瓣发生血管危象,手术探查后皮瓣成活。供区创面均Ⅰ期愈合。16例患儿均获随访,随访时间6个月~16年,平均20.7个月;皮瓣色泽正常,质地较柔软,下肢运动功能满意;根据Punor功能评定标准评定:优12例,良4例。结论胸脐皮瓣联合腹部随意皮瓣设计合理,血供丰富,修复面积大,是一种修复儿童小腿大面积软组织缺损的可靠方法。Objective To investigate the clinical effect of thoracoumbilical flap combined with random abdominal flap in repair of large-area soft tissue defects of calf in children.Methods The clinical data of 16 children with large-area soft tissue defects of calf treated with thoracoumbilical flap combined with abdominal random flap from January 2004 to December 2007 in PLA Trauma Orthopaedic Research Institute,80th Group Military Hospital of the PLA were retrospectively analysed.There were 7 boys and 9 girls aged 8 to 14(11.3 in average)years old.Six cases were crushed by heavy objects,6 crushed by wheels,3 by thermal press and 1 by machine strangulation.After thorough debridement,the wound area ranged from 16.0 cm×9.0 cm to 38.0 cm×15.0 cm.Four cases were treated after 3-10 hours of injury by emergency surgery.Twelve cases received surgeries 0-11 days after hospital admission and wound being stabilised.Doppler ultrasound was used to locate the perforating vessels according to the location,size and shape of the wound.Thoracoumbilical flap combined with abdominal random flap were designed and harvested to repair the wound.The sizes of flaps were 18.0 cm×11.0 cm-40.0 cm×16.0 cm.All patients entered follow-up at the outpatient clinic or through WeChat interviews.The appearance,texture of the flap and limb recovery were checked and recorded.Results After surgery,all of 16 flaps survived,of which 12 flaps had phase-one healing,3 flaps had small area of necrosis at the edge,which healed after repeated dressing changes and 1 flap developed vascular comproise,and survived after surgical exploration.The donor sites healed in phase-one.All 16 children had 6 months to16 years of follow-up,with an average of 20.7 months.The colour of the flaps was normal with soft texture.The motor function of calf was satisfactory.According to Punor functional evaluation criteria,12 cases were in excellent and 4 in good.Conclusion The thoracoumbilical flap combined with abdominal random flap features a reasonable design,strong blood supply and

关 键 词：胸脐皮瓣 腹部随意皮瓣 小腿 软组织缺损 修复 儿童 

分 类 号：R726.5[医药卫生—儿科]