拱顶石皮瓣修复皮瓣供区软组织缺损12例  

Repair of soft tissue defect at flap donor site with keystone flap in 12 cases

作　　者：艾尔班江·沙力 程二林 任鹏[1] 艾合买提江·玉素甫[1] AIERBANJIANG Shali;CHENG Erlin;REN Peng;AIHEMAITIJIANG Yusufu(Department of Microsurgical Repair,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院显微修复外科,乌鲁木齐830011

出　　处：《中华显微外科杂志》2023年第3期309-314,共6页Chinese Journal of Microsurgery

基　　金：中央引导地方科技发展专项资金项目(ZYYD2022A03)。

摘　　要：目的探讨拱顶石皮瓣(KF)修复皮瓣供区软组织缺损的临床疗效。方法2020年10月-2022年12月,新疆医科大学第一附属医院显微修复外科对12例患者行皮瓣移植术,皮瓣供区用KF进行修复。其中修复股外侧肌皮瓣供区3例,腓肠神经营养血管皮瓣供区3例,背阔肌皮瓣供区4例,内踝上岛状皮瓣供区2例。设计KF的面积为15.0 cm×12.0 cm~30.0 cm×20.0 cm。应用KF类型为Ⅰ型3例、ⅡA型5例、ⅡB型2例、悉尼黑色素瘤科(SMU)改良KF设计型2例。术后4例患者电话随访,5例微信随访,3例门诊随访。随访观察皮瓣外观和术后并发症,皮瓣外观使用温哥华瘢痕量表(VSS)、瘢痕外观评估和评定(SCAR)量表进行评分和分析。结果术后平均随访15.9(2~27)个月,所有患者KF移植区域颜色、质地与周围正常皮肤相近,感觉恢复良好。所有患者均未出现骨筋膜室综合征、皮瓣坏死、伤口裂开和静脉回流障碍等并发症。本组末次随访时VSS评分为(2.17±0.58)分,SCAR评分为(5.33±1.23)分,修复结果满意。结论KF作为一个接力皮瓣,可简单有效地修复皮瓣供区缺损,避免了供区软组织缺损直接闭合或植皮修复后出现的伤口裂开等并发症。Objective To explore the clinical effect of keystone flap(KF)on repair of soft tissue defects at the donor site after flap transfer.Methods From October 2020 to December 2022,in the Department of Microsurgical Rapair of First Affiliated Hospital of Xinjiang Medical University,12 patients were repaired with KF after transfer of flaps.There were 3 donor sites for lateral thigh myocutaneous flap,3 for sural nerve nutrient vascular flap,4 for latissimus dorsi myocutaneous flap and 2 for medial supramalleolar island flap.Size of the KF was 15.0 cm×12.0 cm-30.0 cm×20.0 cm.Types of KF were:3 of type Ⅰ,5 of type ⅡA,2 of type ⅡB and 2 of type Sydney Melanoma Unit(SMU)modification KF design.Four patients were reviewed by telephone follow-up,5 by WeChat and 3 with outpatient clinic visits to observe the appearance of the transferred KF and postoperative complications.Appearance of flaps was scored and analysed using Vancouver Scar Scale(VSS)and Scar Cosmesis Assessment and Rating(SCAR).Results The average follow-up period was 15.9(2-27)months.The colour and texture of the transferred KF were similar to that of the surrounding skin,together with good sensation recovery.No complication such as osteofascial compartment syndrome,necrosis,wound dehiscence and venous congestion occurred in all patients.At the final follow-up,the scores for VSS was 2.17±0.58 and the score for SCAR was 5.33±1.23,with satisfactory repairing outcomes.Conclusion As a relay flap,the KF is a simple and effective flap for reconstruction of the defects at the donor site and it can avoid complications that can be caused by direct closure of the soft tissue defect or a wound dehiscence after skin grafting.

关 键 词：拱顶石皮瓣 软组织缺损 皮瓣供区修复 显微外科技术 

分 类 号：R658[医药卫生—外科学]