两种下腹部组织瓣修复四肢大面积皮肤软组织缺损后患者的腹部功能与外形  

Abdominal function and appearance of patients after repairing the extensive skin and soft tissue defects in the limbs with two types of lower abdominal tissue flaps

作　　者：武雷 丁英状 郝敏如 高祥 

机构地区：[1]山东省文登整骨医院骨手显微外科,文登264400 [2]山东省文登整骨医院四肢创伤科,文登264400 [3]山东省文登整骨医院麻醉科,文登264400 [4]山东省文登整骨医院创伤整复科,文登264400

出　　处：《中华烧伤与创面修复杂志》2023年第10期959-967,共9页Chinese Journal of Burns And Wounds

摘　　要：目的研究用2种下腹部组织瓣修复四肢大面积皮肤软组织缺损后患者的腹部功能与外形。方法采用回顾性临床对照研究方法。2016年6月—2022年10月,山东省文登整骨医院骨手显微外科收治符合入选标准的四肢大面积皮肤软组织缺损患者17例,其中男2例、女15例,年龄21~60岁,缺损范围为15.0 cm×10.0 cm~23.0 cm×15.0 cm。按照采用的修复方法,将患者分为采用腹壁下动脉穿支(DIEP)皮瓣游离移植修复缺损创面的DIEP皮瓣组(9例)和采用保留部分肌肉的横行腹直肌肌皮瓣游离移植修复缺损创面的保留部分肌肉的横行腹直肌肌皮瓣组(8例)。术后1、3、5、7、14 d,采用自制组织瓣血运评估量表对组织瓣血运进行评价;术后12个月,采用皮瓣疗效满意度评分标准评价患者对组织瓣修复疗效的满意度;术前、术后3个月、术后12个月,采用自制腹壁强度评价量表对腹壁强度进行评价;术后12个月,采用自制腹部外形评价量表对腹部瘢痕情况、腹部对称程度、脐部外形及复位情况、穿衣过程中腹部隆起情况、腹部两侧褶皱形成情况进行评价。对数据行重复测量方差分析、独立样本t检验、配对样本t检验、Fisher确切概率法检验。结果术后1、3、5、7、14 d,2组患者组织瓣血运评分均无明显变化,组间比较差异均无统计学意义(P>0.05)。术后12个月,DIEP皮瓣组患者对组织瓣修复疗效的满意比为8/9,与保留部分肌肉的横行腹直肌肌皮瓣组的7/8相近(P>0.05)。2组患者术前腹壁强度相近(P>0.05),DIEP皮瓣组患者术后3、12个月腹壁强度均明显强于保留部分肌肉的横行腹直肌肌皮瓣组(t值分别为3.09、3.02,P<0.05);与组内术前比较,DIEP皮瓣组患者术后3个月腹壁强度及保留部分肌肉的横行腹直肌肌皮瓣组患者术后3、12个月腹壁强度均明显减弱(t值分别为6.04、9.71、2.91,P<0.05),DIEP皮瓣组患者术后12个月腹壁强度无明显变化(P>ObjectiveTo study the abdominal function and appearance of patients after repairing the extensive skin and soft tissue defects in the limbs with two types of lower abdominal tissue flaps.MethodsA retrospective clinical controlled study was conducted.From June 2016 to October 2022,17 patients with extensive skin and soft tissue defects in the limbs who met the inclusion criteria were admitted to the Department of Bone Hand Microsurgery of Shandong Wendeng Orthopedic Hospital,including 2 males and 15 females,aged 21-60 years,with a defect ranging from 15.0 cm×10.0 cm to 23.0 cm×15.0 cm.According to the applied repair method,the patients were divided into deep inferior epigastric perforator(DIEP)flap group(9 cases)with the defect wound being repaired by the DIEP flap and muscle sparing transverse rectus abdominis myocutaneous(MS-TRAM)flap group(8 cases)with the defect wound being repaired by the MS-TRAM flap.On post surgery day(PSD)1,3,5,7,and 14,the blood supply of the tissue flaps was evaluated using a self-made tissue flap blood supply evaluation scale.At 12 months after surgery,the patients'satisfaction with the efficacy of tissue flap repair was evaluated using the satisfaction score standard for flap efficacy.Before surgery and at 3 and 12 months after surgery,a self-made abdominal wall strength evaluation scale was used to evaluate the strength of abdominal wall.At 12 months after surgery,a self-made abdominal appearance evaluation scale was used to evaluate the condition of abdominal scars,degree of abdominal symmetry,the appearance and restoration of umbilicus,abdominal protrusion during dressing,and formation of folds on both sides of the abdomen.Data were statistically analyzed with analysis of variance for repeated measurement,independent sample t test,paired sample t test,and Fisher's exact probability test.ResultsOn PSD 1,3,5,7,and 14,there was no significant change in the blood supply score of tissue flaps of patients in the two groups,and there was no statistically significant difference between th

关 键 词：创伤和损伤 外科皮瓣 四肢 病人满意度 腹壁下动脉穿支皮瓣 保留部分肌肉的横行腹直肌肌皮瓣 腹部功能 创面修复 

分 类 号：R622[医药卫生—整形外科]