游离腹股沟皮瓣修复四肢软组织缺损的临床应用  

Clinical application of free groin flap in repairing soft tissue defect in extremities

作　　者：王海波 农朋海 李能文 经维新 唐天贵 唐凤琼 吴欢霖 王静威[2] 沙轲[2] WANG Haibo;NONG Penghai;LI Nengwen;JING Weixin;TANG Tiangui;TANG Fengqiong;WU Huanlin;WANG Jingwei;SHA Ke(Department of Hand and Microsurgery,Guangxi Guilin Xing'an Jieshou Orthopaedic Hospital,Guilin,Guangxi Zhuang Autonomous Region 541306,China;Department of Orthopaedic Trauma and Hand Surgery,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西桂林市兴安县界首骨伤医院显微手外科,广西桂林541306 [2]广西医科大学第一附属医院创伤骨科手外科,南宁530021

出　　处：《中华显微外科杂志》2022年第6期622-628,共7页Chinese Journal of Microsurgery

基　　金：广西高校中青年教师科研基础能力提升项目(2021KY0092)。

摘　　要：目的观察总结游离腹股沟皮瓣修复四肢软组织缺损的临床疗效,探讨该皮瓣轴心血管的选择。方法2018年1月至2021年1月,桂林市兴安界首骨伤医院显微手外科应用游离腹股沟皮瓣修复四肢软组织缺损146例,其中外伤创面126例,慢性溃疡20例。合并骨折、内植物外露86例,伴肌腱、神经、动脉损伤或缺损18例,合并严重感染6例,形成深部死腔3例。创面大小2.0 cm×3.0 cm~25.0 cm×6.0 cm,皮瓣大小与创面相同,不放大。所有皮瓣的轴心动脉均先探查旋髂浅动脉浅支,根据轴心动脉的可用性调整选择皮瓣的供血血管,并记录各轴心血管及其伴行静脉的大小、走行、毗邻和可游离长度。供区创面均直接缝合关闭。所有患者均门诊随访。结果所有病例均采用游离腹股沟皮瓣修复创面,但皮瓣的主要供血血管并不恒定,以旋髂浅动脉为轴心血管141例(96.6%),其中以浅支为轴心133例(94.3%),深支5例(3.6%);以旋髂浅动脉为轴心血管嵌合髂骨穿支修复骨和软组织缺损3例(2.1%)。以腹壁浅动脉为轴心血管的5例(3.4%)。测量动脉口径:旋髂浅动脉浅支外径0.5~0.9 mm,可游离长度7.0~9.0 cm;深支外径1.2~1.4 mm,可游离长度9.0~11.0 cm;腹壁浅动脉外径1.0~1.6 mm,可游离长度8.0~11.3 cm。术后皮瓣全部顺利成活,随访时间为6~40个月,平均26个月,皮瓣质地柔软,外观轻度臃肿,部分可见色素沉着,未见明显皮肤挛缩。结论游离腹股沟皮瓣可用于修复四肢软组织缺损,其最主要的轴心血管是旋髂浅动脉的浅支,其次是深支或主干;若其缺如,也可以腹壁浅动脉作为轴心血管,此时需调整皮瓣设计,而不用改变供区。Objective To observe and summarise the clinical effect of free groin flap in repairing of soft tissue defects in extremities,and to explore the selection of main vessel in a flap.Methods From January 2018 to January 2021,146 patients with soft tissue defects in extremities were treated with free groin flaps in the Department of Hand and Microsurgery,Guangxi Guilin Xing'an Jieshou Orthopaedic Hospital.There were 126 patients with traumatic wound and 20 with chronic ulcer.In addition,86 of the patients with bone fracture and exposure of internal fixator,18 with tendon,nerve or artery injuries or defects.There were 6 patients with severe infection and other 3 with deep dead space.The sizes of wound ranged from 2.0 cm×3.0 cm to 25.0 cm×6.0 cm.The flap was the same size as the wound and not enlarged.Firstly,the superficial branch of superficial iliac circumflex artery was explored as the axial artery for all the flaps,then the blood supply vessels of the flap were selected according to the availability of the axial artery.The size,course,adjacent and possible length to be freed of the axial artery and the accompanying veins of a flap were recorded.The donor sites were directly sutured and closed.All patients were included in the postoperative follow-up at outpatient clinic.Results Free groin flap were used to repair the wounds in all patients.However,the main blood supply vessel of the flap was not constant,and it was often required to adjust the way of flap harvesting.Superficial circumflex iliac artery was taken as the axial vessels in 141 patients(96.6%),among them,133 cases(94.3%)had the superficial branch as the axis and 5 cases(3.6%)had deep branch as the axis.Three patients(2.1%)had the bone and soft tissue defects reconstructed with vascularised iliac mosaic osteocutaneous flap with superficial circumflex iliac artery as axial vessel and 5 cases(3.4%)had the superficial epigastric artery as axial vessel.The axial arteries were measured as follow:the superficial branch of the superficial circumflex iliac arte

关 键 词：腹股沟皮瓣 旋髂浅动脉 四肢 创面 修复 

分 类 号：R658[医药卫生—外科学]