腹壁下动脉穿支皮瓣移植修复下肢创伤性软组织缺损的疗效  

Effect of inferior epigastric artery perforator flap transplantation in repairing traumatic soft tissue defects of lower limbs

作　　者：谭玉忠 艾克拜尔·亚森 程良坤 郑云 田林 Tan Yuzhong;Aikebaier·Yasen;Cheng Liangkun;Zheng Yun;Tian Lin(Trauma Repair Microsurgery Centre,Chongqing Great Wall Hospital,Chongqing 400041,China)

机构地区：[1]重庆长城医院创伤修复显微外科中心,重庆400041

出　　处：《中华创伤杂志》2022年第12期1100-1105,共6页Chinese Journal of Trauma

基　　金：重庆市九龙坡区2019年科技计划(2019-03-015-D)。

摘　　要：目的探讨腹壁下动脉穿支皮瓣移植修复下肢创伤性软组织缺损的疗效。方法采用回顾性病例系列研究分析2019年1月至2021年5月重庆长城医院收治的34例下肢创伤性软组织缺损患者临床资料,其中男31例,女3例;年龄12~65岁[(38.5±5.6)岁]。小腿8例,足踝26例。创面均伴有肌腱、肌肉和(或)骨骼的外露。软组织缺损面积10 cm×6 cm~40 cm×11 cm。均行腹壁下动脉穿支皮瓣移植修复。观察伤口愈合情况、皮瓣成活和恢复情况。术前、术后3,7,14 d及术后1,3,6,12个月采用视觉模拟评分(VAS)评估疼痛情况;采用美国足踝外科协会(AOFAS)踝-后足评分系统评价踝关节功能。观察并发症发生情况。结果患者均获随访12~36个月[(19.5±5.3)个月]。伤口均Ⅰ期愈合,伤口愈合时间14~24 d[(17.6±2.8)d]。皮瓣均成活,颜色良好,质地柔软,外观满意无明显臃肿,均产生保护性感觉。术后7,14 d及术后1,3,6,12个月的VAS分别为(4.3±0.8)分、(3.3±0.7)分、(1.4±0.5)分、(1.2±0.3)分、(0.8±0.2)分、(0.4±0.1)分,较术前的(7.4±1.3)分逐渐降低(P均<0.05);术后7,14 d及术后1,3,6,12个月的AOFAS踝-后足评分分别为(35.6±3.1)分、(42.6±3.6)分、(50.3±4.3)分、(56.2±5.6)分、(60.3±6.8)分、(65.3±9.0)分,较术前的(22.4±2.5)分逐渐增高(P均<0.05)。术后12个月踝关节功能优25例,良5例,可4例,优良率为88.2%。术后3例发生静脉危象,重新吻合静脉或静脉桥接后皮瓣完全成活。结论对于下肢创伤性软组织缺损,腹壁下动脉穿支皮瓣移植修复术后皮瓣成活率高、外观满意,疼痛减轻,踝关节功能恢复好,并发症少。Objective To investigate the effect of inferior epigastric artery perforator flap transplantation in repairing traumatic soft tissue defects of lower limbs.Methods A retrospective case series study was conducted to analyze the clinical data of 34 patients with traumatic soft tissue defects of lower limbs admitted to Chongqing Great Wall Hospital from January 2019 to May 2021,including 31 males and 3 females;aged 12-65 years[(38.5±5.6)years].There were 8 patients with defects on the calf and 26 on the ankle.All wounds were found with exposed tendons,muscles and/or bones.The area of soft tissue defects ranged from 10 cm×6 cm to 40 cm×11 cm.All patients were repaired with inferior epigastric artery perforator flap.The wound healing,flap survival and recovery were observed.The visual analogue scale(VAS)and American Orthopedic Foot and ankle Society(AOFAS)ankle-hindfoot score were used to evaluate pain and ankle function before operation and at 3 days,7 days,14 days,1 month,3 months,6 months and 12 months after operation.The complications were observed.Results All patients were followed up for 12-36 months[(19.5±5.3)months].All wounds were healed by stage I,showing the healing time of 14-24 days[(17.6±2.8)days].All flaps survived with good color,soft texture and satisfactory appearance,with no obvious swelling.All flaps produced protective sensation.The VAS was(4.3±0.8)points,(3.3±0.7)points,(1.4±0.5)points,(1.2±0.3)points,(0.8±0.2)points and(0.4±0.1)points at 7 days,14 days,1 month,3 months,6 months and 12 months after operation,decreased gradually from preoperative(7.4±1.3)points(all P<0.05).The AOFAS ankle-hindfoot score was(35.6±3.1)points,(42.6±3.6)points,(50.3±4.3)points,(56.2±5.6)points,(60.3±6.8)points and(65.3±9.0)points at 7 days,14 days,1 month,3 months,6 months and 12 months after operation,increased from preoperative(22.4±2.5)points(all P<0.05).The ankle function was excellent in 25 patients,good in 5 and fair in 4 at 12 months after operation,with an excellent and good rate of 88.2%.Ve

关 键 词：软组织损伤 下肢 移植 自体 腹壁下动脉穿支皮瓣 

分 类 号：R658.3[医药卫生—外科学]