带蒂股薄肌肌皮瓣修复腹股沟区窦道型慢性创面10例  

Reconstruction of chronic wounds with sinus tract in inguinal region using a pedicled gracilis musculocutaneous flap:a report of 10 cases

作　　者：邓如非 张永宏 陈嘉欣 纪如晨 姜臻宇 邹立津[1] 邓旭辉 张友来[1] DENG Rufei;ZHANG Yonghong;CHEN Jiaxin;JI Ruchen;JIANG Zhenyu;ZOU Lijin;DENG Xuhui;ZHANG Youlai(Medical Centre of Burn Plastic and Wound Repair,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Cosmetic Surgery,Changsha Aist Medical Cosmetology Hospital,Changsha 410007,China)

机构地区：[1]南昌大学第一附属医院烧伤整形与创面修复医学中心,南昌330006 [2]长沙爱思特医疗美容医院美容外科,长沙410007

出　　处：《中华显微外科杂志》2024年第5期528-532,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金地区科学基金(81760343);江西省自然科学基金(20202BABL206072)。

摘　　要：目的探讨带蒂股薄肌肌皮瓣修复腹股沟区窦道型慢性创面的临床效果。方法自2015年9月至2023年6月,南昌大学第一附属医院烧伤整形与创面修复医学中心收治10例腹股沟区窦道型慢性创面患者,其中男6例,女4例,年龄15~72岁,平均45岁。致伤原因:外阴癌或阴茎癌行腹股沟淋巴结清扫术后创面不愈4例,腹股沟区行放疗后形成慢性放射性溃疡2例,下肢动脉球囊扩张成形术术后股动脉造影口不愈2例,腹股沟隆突性皮肤纤维肉瘤切除术后创面不愈1例,腹股沟区瘙痒反复抓挠后破溃不愈1例。患者腹股沟区创面均系慢性创面,病程均超过30 d,且合并窦道形成,软组织缺损范围2.0 cm×3.0 cm~5.0 cm×7.0 cm,窦道深度2.0~5.0 cm。清创后切取同侧带蒂股薄肌肌皮瓣进行修复,皮瓣面积3.5 cm×4.0 cm~8.0 cm×9.0 cm,股薄肌肌瓣长度16.0~24.0 cm,肌瓣体积96.0~180.0 cm^(3)。股薄肌肌瓣填充窦道,皮瓣覆盖创面,皮瓣供区直接拉拢缝合。术后避免髋部活动,适当抬高患侧肢体,观察股薄肌肌皮瓣成活情况及供区创面愈合情况,并定期通过门诊、微信或互联网医院进行随访。结果本组带蒂股薄肌肌皮瓣全部成活,其中1例肌皮瓣术后24 h出现肌瓣断端出血导致皮瓣缝线开裂,经床旁止血及清创缝合后创面愈合。供区创面均I期愈合。10例均获随访,随访时间6~21个月,平均13个月。皮瓣色泽及外观较好,患者对外形满意,肢体供区切口线形瘢痕形成,未见明显功能障碍,供、受区随访期间均未见破溃发生。结论带蒂股薄肌肌皮瓣修复腹股沟区窦道型慢性创面,能充分填充创面窦道同时修复创面软组织缺损,术式简单实用,临床疗效较佳。Objective To explore the clinical effect of a pedicled gracilis musculocutaneous flap on reconstruction of chronic sinus wounds in inguinal region.Methods From September 2015 to June 2023,10 patients with chronic inguinal sinus wounds were treated in Medical Centre of Burn Plastic and Wound Repair,the First Affiliated Hospital of Nanchang University.The patients were 6 males and 4 females,aged 15-72 years old with an average age of 45 years old.Causes of injury:4 patients were of non-healed wound after inguinal lymph node dissection for external genital or penile cancer,2 of chronic radiation ulcers formed in the inguinal area after radiotherapy,2 of femoral artery angiography site non-healing after lower limb artery balloon angioplasty,1 of wound non-healing after resection of inguinal protuberant skin fibrosarcoma,and 1 of non-healing ulceration after repeated scratching due to inguinal pruritus.The wounds were all chronic in the groin region,all with a course over 30 days and sinus formation.Soft tissue defects on the surface of wounds ranged from 2.0 cm×3.0 cm to 5.0 cm×7.0 cm,and the depth of the sinus was from 2.0 cm to 5.0 cm.After debridement,ipsilateral gracilis musculocutaneous flaps were taken for defect reconstruction.Size of the flaps was 3.5 cm×4.0 cm-8.0 cm×9.0 cm,the length of the gracilis musculocutaneous composite flaps was 16.0-24.0 cm,and the volume of the flap was 96.0-180.0 cm^(3).The gracilis tissue of the flap was filled into the sinus tract and the wound was covered by the cutaneous tissue of the flap.Donor sites of the flap were pulled together and directly sutured.After surgery,hip movements were avoided and appropriately raised the affected limb,observed the survival of gracilis musculocutaneous flap as well as the healing of donor site.Scheduled postoperative follow-ups were conducted through the visits of outpatient clinic and interviews via WeChat or Internet hospital.Results All the flaps survived.One flap had bleeding at the edge of flap within 24 hours after surgery and resul

关 键 词：窦道型慢性创面 腹股沟 股薄肌 肌皮瓣 创面修复 显微外科手术 

分 类 号：R622[医药卫生—整形外科]