自主设计的创面测量膜在分叶穿支皮瓣设计中的应用  

A self-designed wound measurement grid in design of lobulated perforator flap

作　　者：周望高 叶学浪 张振伟 庄加川 李东扬 余少校 李征 柯于海 林慧鑫 熊懿 ZHOU Wanggao;YE Xuelang;ZHANG Zhenwei;ZHUANG Jiachuan;LI Dongyang;YU Shaoxiao;Li Zheng;KE Yuhai;LIN Huixin;Xiong Yi(Department of Orthopaedics and Traumatology,Shenzhen Hospital of Integrated Traditional and Western Medicine,Shenzhen,Guangdong Province 518104,China)

机构地区：[1]深圳市中西医结合医院骨伤科,广东深圳518104

出　　处：《中华显微外科杂志》2023年第5期552-557,共6页Chinese Journal of Microsurgery

基　　金：深圳市宝安区科技创新局科研项目(2020JD341)。

摘　　要：目的探讨将自主设计的创面测量膜应用于分叶穿支皮瓣设计的临床效果。方法2019年1月至2022年12月,深圳市中西医结合医院骨伤科对收治的9例四肢软组织缺损伤的患者采用分叶穿支皮瓣进行修复,术中应用自主设计的创面测量膜进行测量,指导分叶穿支皮瓣的设计和切取。其中男7例,女2例,年龄21~55岁,平均40.3岁。修复上肢创面6例,下肢创面3例。旋股外侧动脉降支分叶穿支皮瓣5例,骨间背侧动脉分叶穿支皮瓣4例;软组织缺损面积为4.0 cm×1.5 cm~26.0 cm×8.0 cm,皮瓣切取面积为4.5 cm×1.8 cm~22.0 cm×10.0 cm。术后观察皮瓣血运、皮瓣成活与伤口愈合情况,门诊随访观察皮瓣成活质量、供区恢复情况及肢体功能,采用中华医学会手外科学会上肢部分功能评定试用标准及临床下肢评分(LEM)标准对肢体功能进行评价。结果本组9例患者术后18叶皮瓣成活17叶,1例出现静脉危象,经探查处理后1叶皮瓣出现坏死,再次行游离皮瓣修复术,全部伤口均Ⅰ期愈合。术后随访3~18个月,平均8.6个月,全部皮瓣色泽、质地良好,外观满意,皮瓣供区仅遗留线状瘢痕,无疼痛感及瘢痕挛缩,修复的上肢创面病例依据中华医学会手外科学会上肢部分功能评定试用标准,优4例,良2例。修复的下肢创面病例依据LEM标准评定,结果优2例,良1例。结论自主设计的创面测量膜应用于分叶穿支皮瓣设计,可准确地对创面进行测量,快速提取创面模型,更方便和直观地指导皮瓣设计,临床应用效果良好,值得推广应用。Objective To explore the clinical effect of a self-designed wound measurement grid on the design of lobulated perforator flap.Methods From January 2019 to December 2022,soft tissue defects in limbs of 9 patients were reconstructed by lobulated perforator flaps in the Department of Orthopaedics and Traumatology of Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine.The patients were 7 males and 2 females aged 21-55 years old with 40.3 years old in average.There were 6 upper limb defects and 3 lower limb defects.Self-designed wound measuring grids were applied to guide the design and excision of lobulated perforator flaps during surgery.Five patients were treated by lobulated perforator flap pedicled with the descending branch of lateral circumflex femoral artery and 4 by perforator flaps pedicled with dorsal interosseous artery.The areas of soft tissue defect were 4.0 cm×1.5 cm-26.0 cm×8.0 cm,and the sizes of the flaps were 4.5 cm×1.8 cm-22.0 cm×10.0 cm.After surgery,the blood supply of flaps,flap survival and wound healing were monitored.Flap survival,donor site recovery and limb function were observed at outpatient clinic over the postoperative follow-up,and the limb function was evaluated by the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association and Lower Extremity Measure(LEM).Results In this study,a total of 17 of 18 lobes of the lobulated perforator flaps survived after surgery.One flap had venous occlusion and after exploration and further treatment,a necrosis occurred in 1 lobe of the lobulated flap and then a free flap transfer was performed again.All the wounds achieved stage-I healing.Postoperative follow-up lasted for 3-18 months with 8.6 months in average.All flaps had good colour and texture,satisfactory appearance and only linear scars remained in the donor sites,without pain and scar contracture.The reconstructed upper extremity defect were evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Han

关 键 词：分叶穿支皮瓣 创面测量膜 模型 修复 显微外科技术 

分 类 号：R687.3[医药卫生—骨科学]