游离旋髂浅动脉穿支皮瓣修复小儿手及足软组织缺损  

Reconstruction of soft tissue defect of hand and foot with a free superficial circumflex iliac artery perforator flap in children

作　　者：陈鑫 苑巧巧 宋振磊 李刚强 杨坤 张艳娟 许诺 马光义 CHEN Xin;YUAN Qiaoqiao;SONG Zhenlei;LI Gangqiang;YANG Kun;ZHANG Yanjuan;XU Nuo;MA Guangyi(Department of Hand and Foot Surgery,Zhoukou Huaihai Hospital,Zhoukou Clinical Medical Research Centre for Hand and Foot Surgery,Zhoukou,Henan Province 466001,China)

机构地区：[1]周口淮海医院手足外科,周口市手足外科临床医学研究中心,河南周口466001

出　　处：《中华显微外科杂志》2024年第5期508-513,共6页Chinese Journal of Microsurgery

基　　金：河南省科技研发计划联合基金项目(225101610066);周口市科技发展计划普通科技攻关项目(2023GG02057)。

摘　　要：目的探讨采用游离旋髂浅动脉穿支皮瓣(SCIAPF)修复小儿手、足软组织缺损的临床效果。方法自2021年8月至2023年8月,周口淮海医院手足外科采用游离SCIAPF修复小儿手、足软组织缺损8例,其中男孩6例、女孩2例,年龄2~7岁。软组织缺损部位:左手虎口区累及掌指关节1例,右手背2例,左足背1例,右足内踝2例,右前足2例,均伴有肌腱、骨质外露。软组织缺损面积为2.5 cm×3.0 cm~6.0 cm×3.5 cm。本组先行急诊清创后进行皮瓣移植,皮瓣面积为3.0 cm×3.5 cm~7.0 cm×4.0 cm。供区采用皮内连续缝合法直接闭合。术后对患儿采用门诊复诊、微信联系、登门检查等方式定期随访,观察皮瓣外形、色泽、质地、感觉与手、足功能恢复,以及供区愈合情况。结果术后8例皮瓣均成活,其中1例皮瓣边缘部分坏死,经换药后痂下愈合。皮瓣供区切口均一期愈合。术后随访7~22个月,平均10个月。皮瓣外形轻度臃肿、质地柔软、保护性感觉恢复,手、足功能恢复满意。皮瓣供区遗留线形瘢痕。3例患手功能按中华医学会手外科学会上肢部分功能评定试用标准评定:优1例,良2例。5例患足按Maryland足评分方法评价术后功能:优3例,良2例。结论游离SCIAPF供区隐蔽,切取简单,并发症少,修复效果满意,是修复小儿手、足软组织缺损的一种较理想方法。Objective To explore the clinical efficacy of free superficial circumflex iliac artery perforator flap(SCIAPF)in reconstruction of soft tissue defects of hand and foot in children.Methods From August 2021 to August 2023,free SCIAPFs were used to reconstruct soft tissue defects of hands and feet in 8 children at the Department of Hand and Foot Surgery,Zhoukou Huaihai Hospital.There were 6 boys and 2 girls aged between 2 and 7 years old.The sites of soft tissue defect were:1 of metacarpophalangeal joint in the functional area of left thumb,2 of dorsal right hand,1 of dorsal left foot,2 of medial malleolus of right foot,and 2 of right forefoot,and all were accompanied with tendon and bone exposure.The size of soft tissue defects ranged from 2.5 cm×3.0 cm to 6.0 cm×3.5 cm.After emergency debridement,the children received flap transfers,the flaps sized from 3.0 cm×3.5 cm to 7.0 cm×4.0 cm.Donor sites were closed by running intradermal suture.All children were included in the scheduled postoperative follow-up by visit of outpatient clinic,WeChat interviews and home visits to observe the appearance,colour,texture and sensation of the flaps,the functional recovery of the affected hands and feet,as well as the healing of donor sites.Results After surgery,all 8 flaps survived beside 1 had a partial necrosis at the edge and healed with a scab after dressing change.Flap donor sites healed in one stage.Scheduled postoperative follow-up lasted from 7 to 22 months,with an average of 10 months.The flaps presented a slightly bloated appearance,soft texture with a restored protective sensation and satisfactory functional recovery of hands and feet.Linear scars were left at the donor sites.According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,1 child was of excellent and 2 children of good in hand function of the 3 children with hand injury.The Maryland Foot Score revealed 3 children were of excellent and 2 of good in foot function of the 5 children with foot

关 键 词：旋髂浅动脉穿支皮瓣 小儿 手 足 软组织缺损 

分 类 号：R726.2[医药卫生—儿科]