游离组织瓣修复巨大毁损性烧伤创面的策略及临床效果  

Strategies and clinical effects of free tissue flaps in repairing massive destructive burn wounds

作　　者：张伟 张卫东 陈斓 谢卫国 杨飞 徐军辉 刘峰 Zhang Wei;Zhang Weidong;Chen Lan;Xie Weiguo;Yang Fei;Xu Junhui;Liu Feng(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》2024年第9期818-827,共10页Chinese Journal of Burns And Wounds

基　　金：湖北省自然科学基金(2024AFB470);武汉市知识创新专项曙光计划项目(2022020801020553);武汉市临床医学科研项目(WX20Q18)。

摘　　要：目的探讨游离组织瓣修复巨大毁损性烧伤创面的策略及临床效果。方法该研究为回顾性观察性研究。2014年6月—2023年10月,武汉大学同仁医院暨武汉市第三医院收治有53个符合入选标准的巨大毁损性烧伤创面的51例烧伤患者,其中男47例、女4例,年龄21~77岁。清创后需组织瓣修复的创面面积为20.0 cm×12.5 cm~50.0 cm×15.0 cm,急诊、早期、延期采用组织瓣修复创面。采用背阔肌肌皮瓣修复6个头面颈部创面、5个上肢创面和1个下肢创面,采用股前外侧皮瓣修复11个上肢创面和6个下肢创面,采用脐旁穿支皮瓣修复7个上肢创面、5个下肢创面和2个面颈部创面,采用下腹部皮瓣修复1个下肢创面,采用腹股沟皮瓣修复2个面颈部创面、2个上肢创面和1个下肢创面,采用肩胛皮瓣修复1个上肢创面,采用截肢后弃去的上肢的“剔骨瓣”修复1个躯干创面,采用大网膜瓣修复3个头面颈部创面、3个下肢创面和1个上肢创面。采用前述组织瓣联合移植修复4个创面,采用前述组织瓣分次移植修复3个创面。切取的单个组织瓣面积为15.0 cm×5.0 cm~45.0 cm×25.0 cm。根据情况增加动脉和静脉吻合以改善组织瓣循环。将供瓣区创面直接缝合或移植头部刃厚皮修复。记录治疗期间患者全身情况,术后观察组织瓣成活情况、受区创面愈合情况、保肢情况、供瓣区创面愈合情况和皮片存活情况。随访观察受区创面愈合情况。末次随访时,使用臂、肩、手残障评分表对保肢成功后的上肢功能进行评分,使用Holden步行能力分级评估下肢保肢成功患者的负重行走能力,采用利克特5级量表评价患者对疗效的满意度。结果治疗期间,1例头部电烧伤患者脑水肿加重,形成脑疝再次昏迷,经脱水、激素等治疗后苏醒,遗留右侧肢体不完全偏瘫;4例患者的休克症状加重,经补液抗休克并输入胶体后逐渐得到控制;1例患者于组织�Objective To investigate the strategies and clinical effects of free tissue flaps in repairing massive destructive burn wounds.Methods This study was a retrospective observational study.From June 2014 to October 2023,51 burn patients with 53 massive destructive burn wounds which met the inclusion criteria were admitted to Tongren Hospital of Wuhan University&Wuhan Third Hospital,including 47 males and 4 females,aged 21 to 77 years.After debridement,the wound area needed to be repaired by tissue flaps ranged from 20.0 cm×12.5 cm to 50.0 cm×15.0 cm.Emergency,early,or delayed transplantation of tissue flaps was performed to repair the wounds.Six head,face,and neck wounds,5 upper limb wounds,and 1 lower limb wound were repaired with latissimus dorsi myocutaneous flaps.Eleven upper limb wounds and 6 lower limb wounds were repaired with anterolateral thigh flaps.Seven upper limb wounds,5 lower limb wounds,and 2 face and neck wounds were repaired with paraumbilical perforator flaps.One lower limb wound was repaired with lower abdominal flap.Two face and neck wounds,2 upper limb wounds,and 1 lower limb wound were repaired with inguinal flaps.One upper limb wound was repaired with scapular flap.One trunk wound was repaired with the"fillet flap"from the abandoned upper limb after amputation.Three head,face,and neck wounds,3 lower limb wounds,and 1 upper limb wound were repaired with omental flaps.Four wounds were repaired by combined transplantation of the above-mentioned tissue flaps.Three wounds were repaired by fractional transplantation of the above-mentioned tissue flaps.The size of a single harvested tissue flap ranged from 15.0 cm×5.0 cm to 45.0 cm×25.0 cm.The arterial and venous anastomoses were added as the circumstances might require to improve tissue flap circulation.The wounds in the flap donor sites were sutured directly or repaired by split-thickness skin grafts from head.The general condition of patients during treatment was recorded.After surgery,the survival of tissue flaps,the healing of wounds in the

关 键 词：烧伤 电 软组织损伤 外科皮瓣 肌皮瓣 穿支皮瓣 显微外科手术 动静脉吻合 修复外科手术 

分 类 号：R644[医药卫生—外科学]