远端蒂腓骨短肌肌瓣修复创面并发症原因分析  

Analysis of the causes complications of in wound repair with distal pedicled peroneus brevis muscle flap

作　　者：王道明 蔡金表 张沈屹婷 WANG Daoming;CAI Jinbiao;ZHANG Shenyiting(Department of Hand Surgery,Quanzhou Orthopedic-Traumatological Hospital,Quanzhou,Fujian,362000,China)

机构地区：[1]泉州市正骨医院手外科,福建泉州362000

出　　处：《实用手外科杂志》2024年第3期340-341,362,共3页Journal of Practical Hand Surgery

摘　　要：目的分析远端蒂腓骨短肌肌瓣转移加游离植皮修复创面病例发生并发症的原因,并总结改进措施。方法回顾性分析2022年7月-2023年8月收治的4例远端蒂腓骨短肌肌瓣加游离植皮修复创面病例术后发生并发症的原因。结果4例中,2例术后植皮区下有瘀血块,植皮坏死区约40%,但肌瓣血运良好,经换药后创面瘢痕愈合;1例术中用电刀将肌瓣自腓骨表面切取后,在距旋转点最远端肌瓣渗血缓慢,术后肌瓣远端3/5坏死相应区域植皮坏死,后期行游离组织瓣移植修复创面;1例术后体位不当,肌瓣受压时间过长,至肌瓣坏死伴感染,在清创、换药后肉芽组织生长,二期游离植皮愈合。结论防止术后肌瓣与植皮区瘀血,以免影响皮片成活,减少术中操作对肌肉造成的损害,重视术后患者的体位管理,是提高最终手术效果的关键。Objective To analyze the causes of adverse complications in cases of distal pedicled peroned brevis muscle flap transfer and free skin grafting for wound repair,and to summarize the improvement measures.Methods A retrospective study was conducted on 4 cases of distal pedicled peroned brevis muscle flap combined with free skin grafting for wound repair from July 2022 to August 2023.Analyze the influencing factors of postoperative adverse complications.Results Among the 4 cases,2 patients accumulated blood clots under the skin grafting area after surgery.Approximately 40%of the skin graft area was necrotic,but muscle flap blood supply was feasible.After dressing change,the ulcer healed in the form of scars.For the other case,an electric knife was used to remove the muscle flap from the surface of the fibula during surgery.It was found that the farthest end of the muscle flap from the rotation point had a slow bleeding rate.Postoperative necrosis of the distal muscle flap accounted for 3/5 of the skin graft area.The patient underwent free tissue flap transplantation again to achieve the goal of repairing the wound surface.In the last case,due to improper postoperative posture,the muscle flap was compressed for a long time,leading to muscle flap necrosis and infection.After debridement and dressing change,granulation tissue grew and secondary free skin grafting healed.Conclusion Preventing subcutaneous congestion in the skin graft area after surgery can promote skin graft survival and reduce muscle damage caused by intraoperative procedures.In addition,emphasizing the management of patient position is the key to improving the final surgical effect.

关 键 词：外科组织瓣 移植 并发症 

分 类 号：R687.2[医药卫生—骨科学]