游离颞浅筋膜瓣联合刃厚皮移植修复胫前难愈性创面的临床效果  

Clinical effects of free superficial temporal fascia flap combined with split-thickness thin skin graft in repairing refractory wounds in the anterior tibia

作　　者：张智 张栋梁 计鹏 程静 胡大海 陶克 Zhang Zhi;Zhang Dongliang;Ji Peng;Cheng Jing;Hu Dahai;Tao Ke(Department of Burns and Skin Sugery,Burn Center of PLA,the First Affiliated Hospital of Air Force Military Medical University,Xi′an 710032,China;Department of Wound Repair and Regenerative Medicine Center,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China)

机构地区：[1]空军军医大学第一附属医院全军烧伤中心,烧伤与皮肤外科,西安710032 [2]温州医科大学附属第一医院创面修复与再生医学中心创面修复科,温州325015

出　　处：《中国医师杂志》2024年第3期337-340,344,共5页Journal of Chinese Physician

基　　金：国家自然科学基金(82272269)。

摘　　要：目的观察游离颞浅筋膜瓣联合刃厚皮移植修复胫前难愈性创面的临床效果。方法收集并归纳2019年9月至2023年10月空军军医大学第一附属医院收治的19例符合入选标准的胫前区域软组织缺损患者资料,其中男11例,女8例,年龄19~70岁。创面面积为4.3 cm×5.0 cm~6.8 cm×9.5 cm,创面均伴有肌腱外露,5例患者同时伴有局部骨外露,10例患者伴有不同程度的局部感染,所有患者均一期给予创面清创及持续封闭负压引流治疗控制感染,创面感染控制后,依据创面大小设计并切取等大的颞浅筋膜组织瓣修复创面,同时取头皮刃厚皮覆盖筋膜瓣。结果 19例患者颞浅筋膜瓣全部成活,2例患者因皮片下血肿导致皮片成活差,经过再次皮片移植后创面愈合。术后随访6~24个月,所有患者胫前区域外形满意,踝关节功能恢复良好。供瓣区隐蔽,无明显瘢痕、脱发及秃发等并发症。结论采用游离颞浅筋膜瓣联合刃厚皮移植修复胫前创面,具有抗感染能力强、筋膜瓣菲薄、供瓣区隐蔽及重建支持韧带等优点,是修复胫前区难愈性创面较为理想的修复方法。Objective To observe the clinical effect of free superficial temporal fascia flap combined with split thickness skin transplantation in repairing refractory wounds in the anterior tibia.Methods Data on 19 patients with soft tissue defects in the anterior tibial region who were admitted to the First Affiliated Hospital of Air Force Medical University from September 2019 to October 2023 and met the inclusion criteria were collected and summarized.Among them,11 were males and 8 were females,aged 19-70 years old.The wound area was 4.3 cm×5.0 cm-6.8 cm×9.5 cm,and all wounds were accompanied by tendon exposure.5 patients also had local bone exposure,and 10 patients had varying degrees of local infection.All patients were treated with wound debridement and continuous closed negative pressure drainage to control infection.After controlling the wound infection,an equally large temporal superficial fascia tissue flap was designed and cut according to the size of the wound to repair the wound.At the same time,a scalp split thick skin was taken to cover the fascia flap.Results All 19 patients with superficial temporal fascia flaps survived,while 2 patients had poor skin flap survival due to subcutaneous hematoma.After re-grafting,the wound healed.After follow-up for 6-24 months,all patients were satisfied with the appearance of the anterior tibial region and had good recovery of ankle joint function.The supply valve area was concealed,without obvious scars,hair loss,baldness and other complications.Conclusions The use of free superficial temporal fascia flap combined with split thick skin transplantation for repairing anterior tibial wounds has the advantages of strong anti infection ability,thin fascia flap,concealed donor site,and reconstruction of supporting ligaments.It is an ideal repair method for repairing difficult to heal wounds in the anterior tibial area.

关 键 词：皮肤移植 颞浅筋膜瓣 胫前损伤 创面修复 

分 类 号：R622[医药卫生—整形外科]