VSD与带蒂背阔肌皮瓣转移序贯治疗上肢大面积软组织缺损  

Clinical analysis of VSD combined with pedicled latissimus dorsi musculocutaneous flap sequential transferring for repair of large soft tissue defect of upper extremity

作　　者：任胜 孙彩莲 刘文状 REN Sheng;SUN Cailian;LIU Wenzhuang(Department of Burn and Plastic Surgery,The 942th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force,Yinchuan 750004,Ningxia,China)

机构地区：[1]中国人民解放军联勤保障部队第九四二医院烧伤整形科,宁夏银川750004

出　　处：《中国现代手术学杂志》2024年第3期236-241,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨VSD联合带蒂背阔肌皮瓣转移序贯治疗上肢大面积软组织缺损的临床疗效。方法回顾性分析2016年2月至2023年3月我科收治的上肢大面积软组织缺损64例患者的临床资料,按治疗方法分为治疗组和对照组,各32例,清洁创面后分别采用持续VSD与带蒂背阔肌皮瓣转移序贯治疗、换药+带蒂背阔肌皮瓣转移序贯治疗上肢大面积软组织缺损创面。比较两组手术前住院时间、抗生素使用时间、总住院时间、皮瓣存活情况等,采用Mayo肘关节评分系统评价肘关节功能。结果治疗组手术前住院时间、抗生素使用时间及总住院时间均明显少于对照组,差异有统计学意义(P<0.05)。治疗组术后皮瓣完全存活32例(100%),对照组完全存活29例(90.62%),缺血、感染坏死3例(9.38%);组间比较差异有统计学意义(P<0.05)。术后6个月按Mayo评分标准评价肘关节功能:治疗组优6例,良16例,中8例,差2例,优良率为68.75%,对照组优4例,良14例,中10例,差4例,优良率为56.25%;两组比较差异有统计学意义(P<0.05)。随访7~14个月,平均(12.0±1.9)个月,皮瓣质地柔软,外形满意。结论VSD与带蒂背阔肌皮瓣转移序贯治疗上肢大面积软组织缺损,可有效促进创面愈合,减轻患者换药痛苦,且皮瓣切取简便、易存活,是修复上肢大面积软组织缺损的有效方法。Objective To explore the clinical effect of VSD combined with pedicled latissimus dorsi flap sequential transferring in the treatment of large soft tissue defect of upper extremity.Methods A total of 64 cases with large soft tissue defect of upper extremity were selected and divided into the treatment group and the control group according to treatment method from February 2016 to March 2023,with 32 cases for each group.After debridement of wound,continuous VSD combined with pedicled latissimus dorsi musculocutaneous flap transferring was performed sequentially in the treatment group,and dressing change combined with pedicle latissimus dorsi flap transferring was performed sequentially in the control group.The preoperative hospitalization,application time of antibiotics,total hospitalization and the survival rate of flap were recorded and compared between the two groups.The elbow function was evaluated by Mayo Elbow Performance Score(MEPS).Results Compared with the control group,the preoperative hospitalization time,application time of antibiotics and total hospitalization time of the treatment group were significantly shorter with statistical differences(P<0.05).The flaps survived completely in all 32 cases(100%)of the treatment group and 29 cases(90.62%)of the control group.Ischemia and necrosis of flap was found in 3 cases(9.38%)in the control group.There was statistical difference in the survival rate of flap between the two groups(P<0.05).According the MEPS,the elbow function revealed that excellence was in 6 cases,good in 16 cases,fair in 8 cases and false in 2 cases of the treatment group,and excellence was in 4 cases,good in 14 cases,fair in 10 cases and false in 4 cases in the control group.The fineness rate of the treatment group was significantly higher than that of the control group(68.75%vs.56.25%,P<0.05).All cases were followed up for 7 to 14 months with an average of(12.0±1.9)months.The skin flap appeared a soft texture and satisfactory appearance.Conclusion The treatment of VSD combined with pedic

关 键 词：VSD 背阔肌皮瓣 软组织缺损 上肢 

分 类 号：R658.2[医药卫生—外科学]