游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果  

Clinical effects of free transplantation of inguinal flap in repairing electrical burn wounds of mice in the limbs

作　　者：徐军辉 张伟 周锦秀 陈斓 张卫东 龚翔 谢卫国 Xu Junhui;Zhang Wei;Zhou Jinxiu;Chen Lan;Zhang Weidong;Gong Xiang;Xie Weiguo(Department of Burns,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430060,China)

机构地区：[1]武汉大学同仁医院暨武汉市第三医院烧伤科,武汉430060

出　　处：《中华烧伤与创面修复杂志》2023年第11期1030-1037,共8页Chinese Journal of Burns And Wounds

基　　金：武汉市临床医学科研项目(WX20Q18);武汉市科技局知识创新专项曙光计划项目(2022020801020553)。

摘　　要：目的探讨游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果。方法采用回顾性观察性研究方法。2012年1月—2023年5月, 武汉大学同仁医院暨武汉市第三医院烧伤科收治24例符合入选标准的年龄20~69岁四肢电烧伤男性患者。共27个肢体受累, 其中上肢18个、下肢9个。清创后, 肢体拟用腹股沟皮瓣修复的创面面积为5.0 cm×1.5 cm~20.0 cm×9.0 cm。对24例患者共行26次手术, 切取27个面积为5.0 cm×3.5 cm~22.0 cm×12.0 cm游离腹股沟皮瓣, 其中6个行分叶移植, 2个与髂骨瓣嵌合移植, 3个与带蒂背阔肌肌皮瓣联体移植, 1个与游离脐旁穿支皮瓣联体移植。术中行吲哚菁绿血管造影评估腹股沟皮瓣血运, 指导移植时动脉增压。移植的腹股沟皮瓣中, 5个以旋髂浅动脉与腹壁浅动脉共干为血管蒂, 13个以单纯旋髂浅动脉为血管蒂, 6个以单纯腹壁浅动脉为血管蒂, 其余3个同时吻合旋髂浅动脉和腹壁浅动脉行动脉增压。另对1例患者用旋髂浅动脉的深支作为桥接血管再通示指远节固有动脉。将供区创面直接缝合。记录腹股沟皮瓣切取完毕切断血管前与移植并吻合血管后即刻的血运状态, 术后观察组织瓣成活情况、移植髂骨固定情况、供区继发缺损愈合情况, 随访观察腹股沟皮瓣外观、受区功能恢复情况。末次随访时, 采用臂、肩、手残障(DASH)评分表对受累上肢功能进行评分, 参考利克特量表5级评分法调查患者对每次手术治疗效果的满意度。结果 27个腹股沟皮瓣切取完毕切断血管前与移植并吻合血管后即刻动脉血流灌注与静脉回流均良好。除1个腹股沟皮瓣术后12 d出现坏死, 经头部刃厚皮移植修复外, 其余26个腹股沟皮瓣及联体移植组织瓣术后完全成活, 未发生血管危象;移植髂骨术后固定牢靠;供区继发缺损术后均愈合良好。随访6~36个月, 腹股沟皮瓣质地柔软, 无明显臃肿;受区功能Objective To investigate the clinical effects of free transplantation of inguinal flap in repairing electrical burn wounds of mice in the limbs.Methods A retrospective observational study was conducted.From January 2012 to May 2023,24 male patients with electrical burns in the limbs meeting the inclusion criteria,aged 20 to 69 years,were admitted to the Department of Burns of Tongren Hospital of Wuhan University&Wuhan Third Hospital.Totally 27 limbs were involved,including 18 upper limbs and 9 lower limbs.After debridement,the wound area in the limbs proposed to be repaired with the inguinal flap was 5.0 cm×1.5 cm-20.0 cm×9.0 cm.A total of 26 operations were performed in 24 patients,and 27 free inguinal flaps with area being 5.0 cm×3.5 cm-22.0 cm×12.0 cm were resected,including 6 for lobed transplantation,2 for chimeric transplantation with iliac bone graft,3 for conjoined transplantation with pedicled latissimus dorsi myocutaneous flap,and 1 for conjoined transplantation with free paraumbilical perforator flap.Indocyanine green angiography was used to evaluate the blood supply of the inguinal flap during operation,to guide arterial supercharge during transplantation.Among the transplanted inguinal flaps,5 were pedicled with the common trunk of the superficial circumflex iliac artery and the superficial abdominal wall artery,13 were pedicled with the superficial circumflex iliac artery alone,6 were pedicled with the superficial abdominal wall artery alone,and the remaining 3 were simultaneously anastomosed with the superficial circumflex iliac artery and the superficial abdominal wall artery for arterial supercharge.In another patient,the deep branch of the superficial circumflex iliac artery was used as a bridging vessel to recanalize the proper artery of the index finger in the distal segment.The wound in the donor area were sutured directly.The blood supply status of the inguinal flap immediately after resection but before cutting off blood vessels and after transplantation and vascular anastomosis was rec

关 键 词：烧伤 电 外科皮瓣 腹股沟 游离皮瓣 供区保护 四肢功能 创面修复 

分 类 号：R641[医药卫生—外科学]