穿支蒂风筝皮瓣修复四肢和躯干软组织缺损14例  

Reconstruction of soft tissue defects of limbs and trunk with perforator pedicled kite flap:a report of 14 cases

作　　者：吴攀峰[1] 卿黎明[1] 潘丁[1] 曾磊[1] 刘睿[1] 贺继强[1] 符劲飞 唐举玉[1] WU Panfeng;QING Liming;PAN Ding;ZENG Lei;LIU Rui;HE Jiqiang;FU Jinfei;TANG Juyu(Department of Hand Microsurgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008

出　　处：《中华显微外科杂志》2024年第4期388-392,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81871577,81901978,82072194);湖南省自然科学基金(2022JJ30970)。

摘　　要：目的探讨穿支蒂风筝皮瓣修复四肢和躯干软组织缺损的可行性,总结其临床疗效。方法回顾性分析2016年1月-2023年9月在中南大学湘雅医院手显微外科收治的14例软组织缺损患者,男6例,女8例;其中缺损位于小腿7例,骶尾部2例,背部2例,前臂3例,软组织缺损面积2.2 cm×1.8 cm~8.0 cm×16.0 cm;均采用穿支蒂风筝皮瓣修复,其中单穿支蒂6例,双穿支蒂3例,3穿支蒂4例,5穿支蒂1例;单V-Y推进8例,双V-Y推进6例;皮瓣面积3.0 cm×5.5 cm~9.0 cm×23.0 cm,皮瓣供区均一期缝合关闭。术后采用微信、电话和门诊等方式进行随访,观察、记录皮瓣成活情况和并发症。结果本组14例皮瓣均完全成活。皮瓣与供区创面均一期愈合。随访3~36(平均14.5)个月,13例皮瓣质地柔软,形态良好,质地与周围正常皮肤相近,外形良好,未见明显臃肿,修复效果满意。1例患者原创面处局部溃疡伴渗出,取出钢板彻底扩创后伤口愈合良好。结论穿支蒂风筝皮瓣不需要吻合血管,不需要牺牲第二供区,移动范围大,术式简单,术后外形良好,是修复躯干、四肢中小面积软组织缺损较为理想的方法,适合在基层医院推广。ObjectiveTo explore the feasibility for reconstruction of soft tissue defects in limbs and trunk with perforator pedicled kite flap,and to summarise its clinical efficacy.MethodsA retrospective study was conducted on 14 patients with soft tissue defects and admitted to the Department of Hand Microsurgery of Xiangya Hospital,Central South University from January 2016 to September 2023.Among the 14 patients(6 males and 8 females),7 had defects in calf,2 in sacrococcygeal area,2 in the back and 3 in forearm.All of the defects were reconstructed with the perforator pedicled kite flaps,of which 6 flaps had the pedicles of single perforator,3 of 2 perforators,4 of 3 perforators and 1 of 5 perforators.Single V-Y advancement flaps were used for defect reconstruction in 8 patients,and double V-Y advancement flaps were used in 6 patients.The size of the defects ranged from 2.2 cm×1.8 cm to 8.0 cm×16.0 cm,and the size of the flaps ranged from 3.0 cm×5.5 cm to 9.0 cm×23.0 cm.All donor sites were closed directly.Postoperative follow-up was conducted at outpatient clinic,by telephone reviews and WeChat after surgery,to observe the flap survival and postoperative complications.ResultsAll flaps survived completely.All the flaps and donor sites healed primarily.The postoperative follow-up lasted for 3 to 36(mean,14.5)months.Thirteen flaps presented with soft texture,good appearance,with similar texture to the surrounding skin and without obvious swelling.The patients were satisfied with the aesthetic outcomes.One patient had a local ulcer with exudation at the recipient site and the ulcer healed after removal of the steel plate and thoroughly debridement.ConclusionWith a perforator pedicled kite flap,vascular anastomosis or sacrifice of a second donor site can be avoided.A perforator pedicled kite flap can be applied to many recipient sites,with a simple surgical procedure and a good postoperative appearance.It is an ideal flap for reconstruction of small to medium-sized soft tissue defects in trunk and limbs.More studies are

关 键 词：穿支皮瓣 风筝皮瓣 穿支螺旋桨皮瓣 穿支蒂 软组织缺损 

分 类 号：R658[医药卫生—外科学]