三种穿支蒂皮瓣修复肘关节周围软组织缺损的回顾性分析  

Retrospective analysis of three kinds of pedicled perforator flaps for repairing soft tissue defects around the elbow joint

作　　者：林涧 吴立志 王相 张天浩 王之江 郑和平 Lin Jian;Wu Lizhi;Wang Xiang;Zhang Tianhao;Wang Zhijiang;Zheng Heping(Department of Center for Orthopaedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences(Xinhua Hospital Chongming Branch),Institute of Wound Prevention and Treatment,Shanghai University of Medicine and Health Sciences,Shanghai 202150,China;Department of Hand Surgery,Taizhou Hospital of Zhejiang Province,Wenzhou Medical University,Taizhou 317000,China;Department of Microsurgery,the 906th Hospital of the Joint Logistic Support Force of PLA,Ningbo 315010,China;Department of Comparative Medicine,the 900th Hospital of the Joint Logistic Support Force of PLA,Fuzhou 350025,China)

机构地区：[1]上海健康医学院附属崇明医院(上海新华医院崇明分院)骨科修复重建中心、上海健康医学院创面防治研究所,上海202150 [2]温州医科大学附属台州医院手外科,台州317000 [3]解放军联勤保障部队第906医院修复重建显微外科,宁波315010 [4]解放军联勤保障部队第900医院比较医学科,福州350025

出　　处：《中华整形外科杂志》2023年第9期929-938,共10页Chinese Journal of Plastic Surgery

基　　金：上海市科研计划面上项目(14411973200);上海市卫生和计划生育委员会面上项目(201840198);上海市卫生健康委员会专项研究基金项目(2020YJZX0143)。

摘　　要：目的探讨3种穿支蒂皮瓣修复肘关节周围软组织缺损的临床效果及适应证。方法回顾性分析2013年12月至2022年11月,上海健康医学院附属崇明医院(上海新华医院崇明分院)骨科修复重建中心收治的肘关节周围软组织缺损患者的临床资料。根据受区缺损部位、形状、面积及供区穿支血管穿出点,在上臂中下段设计上臂内侧远端穿支蒂皮神经营养血管皮瓣,在前臂近端设计肘下动脉穿支蒂螺旋桨皮瓣或骨间后动脉穿支蒂V-Y推进皮瓣,转位修复肘关节周围创面;供区直接拉拢缝合,或切取患肢较隐蔽区全厚皮片移植修复。术后对供、受区进行随访观察,并在末次随访时从以下3个方面对修复效果进行评价。(1)由患者对治疗效果进行自我评价,分为满意、一般、不满意3个等级;(2)肘关节功能评价:参照Mayo肘关节功能评分标准进行评价,分为优、良、可、差4个等级;(3)综合评价:参考下肢踝关节周围创面修复评价标准进行评分,16~21分为优,11~15分为良,6~10分为可,0~5分为差,同时计算优良比例,即优、良例数之和/总例数×100%。结果共纳入51例患者,男31例,女20例;年龄16~87岁,平均56.1岁;缺损位于肘前区20例,肘后侧18例,肘关节内侧8例,肘关节外侧5例;清创后缺损面积为3.5 cm×2.5 cm~16.0 cm×6.0 cm。51例患者中采用上臂内侧远端穿支蒂皮神经营养血管皮瓣修复21例,肘下动脉穿支蒂螺旋桨皮瓣修复19例,前臂近端骨间后动脉穿支蒂V-Y推进皮瓣修复11例,皮瓣切取面积为4.5 cm×3.5 cm~18.0 cm×8.0 cm。术后46例皮瓣完全成活,5例皮瓣远端边缘不同程度坏死(≤1.5 cm×1.0 cm),其中上臂内侧远端穿支蒂皮神经营养血管皮瓣2例,肘下动脉穿支蒂螺旋桨皮瓣2例,前臂近端骨间后动脉穿支蒂V-Y推进皮瓣1例,均经换药处理后愈合。术后随访3~60个月,平均12个月,受区皮瓣存活良好,外观不臃肿,色泽、弹性与正常皮肤接近Objective To investigate the clinical effect and indications of the three kinds of pedicled perforator flaps in repairing soft tissue defects around the elbow joint.Methods The clinical data of patients with soft tissue defects around the elbow joint,admitted to the Department of Center for Orthopaedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine&Health Sciences(Xinhua Hospital Chongming Branch)from December 2013 to November 2022 were retrospectively analyzed.The distal based medial antebrachial neurocutaneous flap in the middle and distal part of the upper arm,the perforator pedicled propeller flap of inferior cubital artery or the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery in the proximal forearm were respectively designed according to the location,appearance,size of the recipient site and the perforating point of the perforating vessel in the donor site to repair soft tissue defects around the elbow joint.The donor site was directly closed or covered by free skin grafting cut from the hidden area of the affected limb.The donor and recipient sites were followed up and observed to evaluate the curative effect from the following three aspects.(1)The self-evaluation of the curative effect was divided into three grades:satisfactory,general and unsatisfactory.(2)Elbow joint function evaluation:according to Mayo’s elbow joint function scoring standard which was divided into four grades:excellent,good,general and poor.(3)Comprehensive evaluation:the evaluation criteria for wound repair around the ankle joint of the lower extremity were used for scoring:16 to 21 points as excellent,11 to 15 points as good,6 to 10 points as general,0 to 5 points as poor,and the excellent and good ratio was calculated at the same time,that is,the sum of the number of excellent and good cases/the total number of cases×100%.Results A total of 51 patients were enrolled,including 31 males and 20 females.The age ranged from 16 to 87 years o

关 键 词：外科皮瓣 穿支皮瓣 肘关节 软组织缺损 修复外科手术 

分 类 号：R658.2[医药卫生—外科学]