足踝部高压电烧伤创面修复的带蒂轴型皮瓣选择策略  

Selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle

作　　者：仲海燕 陈勇 杜轩宇 王倩 王慜 邹鸣立 袁斯明 Zhong Haiyan;Chen Yong;Du Xuanyu;Wang Qian;Wang Min;Zou Mingli;Yuan Siming(Department of Burn and Plastic Surgery,General Hospital of Eastern Theater Command,Nanjing 210002,China)

机构地区：[1]东部战区总医院烧伤整形科,南京210002

出　　处：《中华烧伤与创面修复杂志》2023年第10期939-946,共8页Chinese Journal of Burns And Wounds

基　　金：江苏省333工程科研项目(BRA2020416)。

摘　　要：目的探讨足踝部高压电烧伤创面修复的带蒂轴型皮瓣选择策略。方法采用回顾性观察性研究方法。2017年1月—2022年12月,东部战区总医院收治16例高压电烧伤后足踝部皮肤软组织缺损患者,其中单侧缺损者11例、双侧缺损者5例。所有患者均为男性,年龄为25~75岁。彻底清创后拟用皮瓣修复的创面面积为5.0 cm×4.0 cm~12.0 cm×8.0 cm。术前采用彩色多普勒超声、CT血管造影、数字减影血管造影等充分评估患肢血管损伤程度,明确血管网的分布和交通吻合情况,及早应用具有可靠血运的带蒂轴型皮瓣修复创面,皮瓣面积为3.0 cm×2.0 cm~13.0 cm×8.0 cm。供瓣区创面采用头部刃厚皮或大腿中厚皮修复。统计足踝部各区创面采用的皮瓣情况,术后观察皮瓣和皮片成活情况。术后随访观察皮瓣外观、患者行走功能。末次随访,采用美国足踝外科协会踝-后足评分系统评估足踝部功能并评级。结果采用逆行足背皮瓣修复2个趾区创面,采用足底内侧皮瓣修复3个内踝区创面、2个足跟区创面,采用逆行足底内侧皮瓣修复2个足底前区合并趾区创面,采用逆行足内侧皮瓣修复2个足底前区合并趾区创面、5个足底前区创面,采用趾足底固有动脉皮瓣修复1个趾区创面,采用外踝上穿支皮瓣修复1个足背区创面、1个外踝区创面,采用腓肠神经营养血管皮瓣修复1个外踝区创面、1个足背区创面。1例患者术后皮瓣出现静脉回流障碍,经治疗后成活;其余皮瓣和皮片术后完全成活。术后随访6~24个月,皮瓣外观较佳,患者行走功能正常。末次随访时,患者足踝部功能评分为76~95分,评级为优者11例、良者5例。结论根据足踝部高压电烧伤情况,早期彻底清创,术前采用影像学检查方法评估患肢血管情况,选择血运可靠的带蒂轴型皮瓣是修复足踝部高压电烧伤创面及重建相关功能的较好方法。ObjectiveTo explore the selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle.MethodsThe retrospective observational research method was used.From January 2017 to December 2022,16 patients with skin and soft tissue defects in foot and ankle after high-voltage electric burns were treated in General Hospital of Eastern Theater Command,including 11 cases of unilateral defect and 5 cases of bilateral defect.All patients were male,aged from 25 to 75 years.After thorough debridement,the area of the defect to be repaired with the flap was 5.0 cm×4.0 cm to 12.0 cm×8.0 cm.Before operation,the color Doppler ultrasound,computed tomography angiography,or digital subtraction angiography was used to fully evaluate the degree of vascular injury in the affected limb and to identify the distribution and traffic anastomosis of vascular network.Pedicled axial flaps with reliable blood supply were used to repair the wounds as soon as possible,and the area of flaps ranged from 3.0 cm×2.0 cm to 13.0 cm×8.0 cm.The wound in the donor area of flaps was repaired with split-thickness skin graft from head or medium-thickness skin graft from thigh.The flap repair of wounds in various areas of the ankle and foot was recorded.The postoperative survivals of the flaps and skin grafts were observed after surgery.The postoperative appearance of flaps and walking function of patients were followed up.At the last follow-up,the foot and ankle function was evaluated and rated using the American Association of Foot and Ankle Surgeons Ankle Posterior Foot Scoring System.ResultsTwo wounds in toe area were repaired with reverse dorsal pedis flaps,3 wounds in medial ankle area and 2 wounds in heel area were repaired with medial plantar flaps,2 wounds in anterior plantar area combined with toe area were repaired with reverse medial plantar flaps,2 wounds in anterior plantar area combined with toe area and 5 wounds in anterior plantar area were repaired with reverse medial pedis flaps,1 wound in toe

关 键 词：烧伤 电 足 踝 带蒂轴型皮瓣 皮肤软组织缺损 创面修复 

分 类 号：R644[医药卫生—外科学]