超回流技术在尺动脉腕上皮支皮瓣修复手、腕部皮肤缺损中的应用效果  

Application effect of the flap based on ascending branch of the supracarpal cutaneous branch of ulnar artery with venous superdrainage in repairing skin defects of wrist and hand

作　　者：王红涛 王辉[1] 张一晗 许奥 吕梓宸 Wang Hongtao;Wang Hui;Zhang Yihan;Xu Ao;Lyu Zichen(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan 063000,China)

机构地区：[1]唐山市第二医院手外科,唐山063000

出　　处：《中华整形外科杂志》2022年第11期1270-1275,共6页Chinese Journal of Plastic Surgery

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：目的探讨超回流技术在尺动脉腕上皮支皮瓣修复手、腕部皮肤缺损的应用效果。方法回顾性分析2014年7月至2021年3月唐山市第二医院急诊收治的采用尺动脉腕上皮支皮瓣修复手、腕部皮肤缺损患者的临床资料, 根据术中是否吻合静脉将其分为超回流技术组(2017年7月至2021年3月)和传统方法组(2014年7月至2017年6月)。超回流技术组在传统方法的基础上, 将皮瓣携带的皮下静脉与创面周围皮下静脉行端端吻合。2组供区均直接拉拢缝合或游离中厚或全厚皮片移植修复。术后观察2组皮瓣成活情况, 采用Fisher确切概率法比较2组患者皮瓣张力性水疱和色素沉着的发生率, P<0.05为差异有统计学意义。结果共纳入51例患者, 其中超回流技术组27例, 男18例, 女9例, 年龄18 ~ 57岁, 清创后创面面积为6 cm × 2 cm ~ 13 cm × 4 cm;传统组24例, 男15例, 女9例, 年龄20 ~ 61岁, 清创后创面面积为7 cm × 2 cm ~ 14 cm × 3 cm。超回流技术组切取皮瓣面积为7 cm × 3 cm ~ 15 cm × 6 cm, 术后全部成活, 未发生感染, 皮瓣均未出现张力性水疱;随访8 ~ 22个月, 1例皮瓣出现色素沉着。传统组切取皮瓣面积为8 cm × 3 cm ~ 16 cm × 4 cm, 术后有5例皮瓣因静脉回流障碍出现张力性水疱, 拆除蒂部部分缝线及换药处理后皮瓣成活, 未发生感染;随访8 ~ 23个月, 7例皮瓣出现色素沉着。超回流技术组患者皮瓣张力性水疱和色素沉着发生率分别为0(0/27)和3.7%(1/27), 明显低于传统组的20.8%(5/24)和29.2%(7/24), 差异均有统计学意义(P均<0.05)。结论在尺动脉腕上皮支皮瓣修复手、腕部皮肤缺损中采用超回流技术, 可降低皮瓣出现静脉回流障碍的风险, 有效减少皮瓣张力性水疱和色素沉着的发生率。Objective To investigate the application effect of venous superdrainage in repairing skin defects of wrist and hand with the flap based on ascending branch of the supracarpal cutaneous branch of ulnar artery.Methods From July 2014 to March 2021,the clinical data of patients with hand and wrist skin defects repaired with the flap based on ascending branch of the supracarpal cutaneous branch of ulnar artery in the Emergency Department of Tangshan Second Hospital were retrospectively analyzed.According to the intraoperative venous anastomosis or not the patients were divided into venous superdrainage group(from July 2017 to March 2021)and traditional group(from July 2014 to June 2017).On the basis of the traditional method,the subcutaneous vein carried by the flap and the subcutaneous vein around the wound were anastomosed end to end in the venous superdrainage group.The donor sites in both groups were directly sutured or repaired with free partial or full thickness skin grafts.The survival of flaps in the two groups was observed after operation.Fisher’s exact test was used to compare the incidence of tension blister and pigmentation between the two groups.P<0.05 was considered statistically significant.Results A total of 51 patients were enrolled.There were 27 patients in the venous superdrainage group,which including 18 males and 9 females,aged 18 to 57 years.The wound area after debridement ranged from 6 cm×2 cm to 13 cm×4 cm.There were 24 patients in traditional group,which including 15 males and 9 females,aged 20 to 61 years.The wound size after debridement ranged from 7 cm×2 cm to 14 cm×3 cm.In the venous superdrainage group,the flap size ranged from 7 cm×3 cm to 15 cm×6 cm.All the flaps survived without infection and tension blisters.During the follow-up period of 8 to 22 months,one flap showed pigmentation.In the traditional group,the area of flaps ranged from 8 cm×3 cm to 16 cm×4 cm.Tension blisters occurred in 5 cases of flaps due to venous reflux disorder,and the flaps survived without infection

关 键 词：外科皮瓣 尺动脉腕上皮支皮瓣 皮肤缺损 静脉超回流 静脉吻合 

分 类 号：R658.2[医药卫生—外科学]