下腹壁联合皮瓣修复四肢大面积软组织环形缺损  

Coryoint flap of lower abdominal wall for covering extremely large soft tissue circular defects on limbs

作　　者：黄宇 黄波 刘安铭 唐林 周鑫 王韶亮 邹永根 HUANG Yu;HUANG Bo;LIU Anming;TANG Lin;ZHOU Xin;WANG Shaoliang;ZOU Yonggen(Department of Hand Surgery,The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou,Sichuan Province 646000,China;Department of Plastic and Cosmetic Surgery,Xinqiao Hospital,Chongqing 400037,China;Department of Orthopaedics,The People's Hospital of Guizhou Province,Guiyang 550000,China)

机构地区：[1]西南医科大学附属中医医院手外科,四川泸州646000 [2]重庆新桥医院整形美容科,重庆400037 [3]贵州省人民医院骨科,贵阳550000

出　　处：《中华显微外科杂志》2023年第1期44-49,共6页Chinese Journal of Microsurgery

摘　　要：目的探讨携带两套血供的下腹壁联合(体)皮瓣修复四肢大面积软组织环形缺损的疗效。方法 2018年3月-2020年6月,西南医科大学附属中医医院手外科收治脱套伤致四肢大面积软组织环形缺损患者15例,缺损范围:25.0 cm×9.0 cm~30.0 cm×18.0 cm。急诊予以彻底清创及创面VSD处理,待创面肉芽组织红润后,以下腹壁为供区,根据创面特征设计形状及大小匹配的联合皮瓣。穿支组合包括腹壁下动脉(DIEA)、腹壁浅动脉(SIEA)以及旋髂浅动脉(SCIA)。供区直接Ⅰ期闭合。由同一组医生门诊随访评估术后效果。结果术后除1例皮瓣边缘部分坏死,经Ⅱ期植皮后愈合,其余14例皮瓣全部成活,供、受区创面均Ⅰ期愈合。随访时间18~24个月,平均20个月。皮瓣外形满意,质地柔软,末次随访时未出现异常毛发生长、色素沉着等;供区仅遗留线形瘢痕,未出现腹壁疝等并发症。7例上肢功能重建按臂、肩和手功能评定标准(DASH)评分,优5例、良2例;8例下肢功能重建按下肢功能评定标准(LEFS)评分,优5例、良3例。结论携带双血供的下腹壁联合皮瓣供区隐蔽,设计简单,穿支搭配灵活,切取面积大,能修复肢体大面积软组织环形缺损,以最大程度实现保肢治疗。Objective To investigate the results of coryoint flap harvested from lower abdominal wall for covering extremely soft tissue circular defects on limbs.Methods From March 2018 to June 2020,15 patients who suffered from severe degloved injury were admitted into the Department of Hand Surgery,The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University.The injuries were characterised as extreme circular defects on limbs.The dimension of defects ranged from 25.0 cm×9.0 cm to 30.0 cm×18.0 cm.All wounds were taken through emergency debridement and managed by VSD.Using lower abdomen as a donor site,a conjoined flap was dissected when the wound surface became granulating.The perforator vessels of the flaps included vessels of deep inferior epigastric artery(DIEA),superficial inferior epigastric artery(SIEA)and superficial circumflex iliac artery(SCIA).The donor sites were primary closed.Postoperative follow-ups were conducted by the surgeons in the same surgical team at outpatient clinic.Results Fourteen flaps survived completely without significant complications.Distal necrosis occurred in 1 flap,which healed with a skin graft in the second stage surgery.All flaps were reviewed during the postoperative follow-up that lasted for 18-24(mean 20)months.The aesthetic outcomes were achieved on the recipient site without hairy nor hyper-pigmentation.A concealed linea scare left at the donor sites without hernia and limited function.At the last follow-up,5 patients were in excellent and 2 in good evaluated by following the Disabilities of the arm,shoulder and hand(DASH).With the Lower extremity functional scale(LEFS),5 patients were in excellent and 3 in good.Conclusion The simultaneous reconstruction of extremely large soft tissue circular defects on limbs with best possible salvage surgery can be achieved by a conjoined flap.A conjoined flap offers a concealed donor site,easy to design,flexible perforators design and larger size of soft tissue.

关 键 词：下腹壁 联合皮瓣 四肢 软组织缺损 重建 

分 类 号：R622[医药卫生—整形外科]