以旋髂深动脉为蒂的髂骨肌皮瓣修复合并空腔的下肢复合缺损创面  

Clinical application of iliac myocutaneous flap pedicled with deep circumflex iliac artery in repair of complex defect of lower limb with cavity

作　　者：唐林 周鑫 黄宇 刘安铭 陈孝均 TANG Lin;ZHOU Xin;HUANG Yu;LIU Anming;CHEN Xiaojun(Department of Orthopedics,Jiangbei Campus,the First Affiliated Hospital of Army Medical University,Chongqing,400020,P.R.China;Department of Plastic and Cosmetic Surgery,the Second Hospital of Army Medical University,Chongqing,400037,P.R.China;Department of Hand Surgery,the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou Sichuan,646000,P.R.China)

机构地区：[1]陆军军医大学第一附属医院江北院区骨科,重庆400020 [2]陆军军医大学第二附属医院整形美容科,重庆400037 [3]西南医科大学附属中医医院手外科,四川泸州646000

出　　处：《中国修复重建外科杂志》2024年第9期1105-1110,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨以旋髂深动脉(deep circumflex iliac artery,DCIA)为蒂的髂骨肌皮瓣修复合并空腔的下肢复合缺损创面的临床疗效。方法回顾分析2017年3月—2020年9月收治的7例下肢复合缺损创面患者临床资料,男4例,女3例;年龄24~58岁,中位年龄37岁。致伤原因:机器绞伤2例,高处坠落伤2例,交通事故伤3例。创面污染严重,根据Gustilo-Anderson分型:Ⅲa型1例,Ⅲb型4例,Ⅲc型2例(合并胫前动脉断裂);骨折国际内固定研究协会/美国骨创伤协会(AO/OTA)分型:42-C3型2例,43-A2型2例,43-B1型3例。受伤至入院时间为2~10 h,平均6 h。一期急诊清创后均遗留胫骨骨缺损及周围软组织缺损,伴深部空腔形成;二期根据创面特征设计DCIA嵌合髂骨肌皮瓣三维立体修复复合缺损,髂骨瓣切取范围为2.0 cm×2.0 cm×2.0 cm~7.0 cm×3.0 cm×2.5 cm,皮瓣切取范围为12.0 cm×8.0 cm~21.0 cm×13.0 cm,腹内斜肌肌瓣切取范围为3.0 cm×2.0 cm×2.0 cm~5.5 cm×4.0 cm×4.0 cm。供区直接一期闭合。结果术后除1例皮瓣边缘部分坏死,经二期植皮后愈合外,其余皮瓣全部成活;供、受区创面均Ⅰ期愈合。7例患者均获随访,随访时间16~24个月,平均18个月。骨缺损断端愈合良好,愈合时间8~10个月,平均7.3个月。末次随访时,皮瓣外形满意,质地柔软,未出现异常毛发生长、色素沉着等。供区仅遗留线性瘢痕,未出现腹壁疝等并发症。根据Paley骨折愈合评分标准评价骨愈合情况,优5例、良2例。肢体功能重建满意,术后12~16个月实现完全负重,根据下肢功能评定标准(LEFS)评价,优6例、良1例。结论以DCIA为蒂的髂骨肌皮瓣设计灵活,组织成分高度自由,能立体修复合并深部空腔的下肢复合缺损创面,最大程度修复肢体外形及重建负重功能。Objective To explore the effectiveness of iliac myocutaneous flap pedicled with deep circumflex iliac artery(DCIA)on the repair of lower limb composite defect wounds with cavity.Methods A retrospective analysis of 7 patients with lower limb composite defect wounds treated between March 2017 and September 2020 was conducted,including 4 males and 3 females,aged 24-58 years,with a median age of 37 years.The causes of injury were machine twisting injury in 2 cases,fall from height injury in 2 cases,and traffic accident injury in 3 cases.According to Gustilo-Anderson classification,there were 1 case of typeⅢa,4 cases of typeⅢb,and 2 cases of typeⅢc(combined with anterior tibial artery rupture);according to AO/Orthopaedic Trauma Association(AO/OTA)classification,there were 2 cases of type 42-C3,2 cases of type 43-A2,and 3 cases of type 43-B1.The time from injury to admission ranged from 2 to 10 hours,with an average of 6 hours.Tibial bone defect and surrounding soft tissue defect with deep cavity were left after primary emergency debridement.In the second stage,according to the characteristics of the wound,the three-dimensional repair of the composite defect was designed with DCIA embedded iliac myocutaneous flap.The size of the iliac flap was 2.0 cm×2.0 cm×2.0 cm to 7.0 cm×3.0 cm×2.5 cm,and the size of the flap was 12.0 cm×8.0 cm to 21.0 cm×13.0 cm.The internal oblique muscle flap was harvested in size of 3.0 cm×2.0 cm×2.0 cm to 5.5 cm×4.0 cm×4.0 cm.The donor site was primarily closed.Results All the flaps survived after operation,except for 1 case of partial necrosis of the flap edge,which healed after secondary skin grafting,and the donor and recipient wounds healed by first intention.All patients were followed up 16-24 months,with an average of 18 months.The broken end of the bone defect healed well,and the healing time was 8-10 months,with an average of 7.3 months.At last follow-up,the shape of the flap was satisfactory,the texture was soft,and there was no abnormal hair growth,pigmentation,and so

关 键 词：旋髂深动脉 髂骨肌皮瓣 下肢重建 复合缺损 

分 类 号：R658.3[医药卫生—外科学]