带蒂胸廓内动脉第5肋间穿支皮瓣修复胸骨区创面10例  

Reconstruction of chest wound with the pedicled 5th intercostal perforator flap of the internal thoracic artery:a report of 10 cases

作　　者：邓如非 张永宏 陈燕微 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 Yanwei;CHEN Jiaxin;JI Ruchen;JIANG Zhenyu;ZOU Lijin;DENG Xuhui;ZHANG Youlai(Medical Centre of Burn Plastic Surgery and Wound Repair,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Cosmetic Surgery,Changsha Aist Medical Cosmetology Hospital,Changsha 410000,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410000

出　　处：《中华显微外科杂志》2024年第6期614-619,共6页Chinese Journal of Microsurgery

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

摘　　要：目的探讨带蒂胸廓内动脉第5肋间穿支皮瓣修复胸骨切开术后胸骨区瘢痕疙瘩和(或)瘢痕溃疡切除术后软组织缺损创面的可行性及临床效果。方法自2016年9月至2023年8月,南昌大学第一附属医院烧伤整形与创面修复医学中心共收治胸骨切开术后胸骨区瘢痕疙瘩和(或)瘢痕溃疡10例,其中男7例,女3例,年龄17~65岁,平均43岁。胸骨区瘢痕病史2~15年,平均5.5年,瘢痕面积2.0 cm×6.5 cm~5.5 cm×10.0 cm。入院后行手术切除瘢痕疙瘩和(或)瘢痕溃疡,术后软组织缺损创面范围2.5 cm×7.0 cm~6.0 cm×10.5 cm,均一期行带蒂胸廓内动脉第5肋间穿支皮瓣转移修复术,切取皮瓣大小3.5 cm×7.5 cm~6.0 cm×11.0 cm,供区直接拉拢缝合。术后观察患者切口愈合及皮瓣成活情况,并定期通过门诊、互联网医院或微信进行随访,随访患处皮瓣色泽、外观以及瘢痕疙瘩和(或)瘢痕溃疡复发情况、供区外观和继发功能障碍情况。结果本组术后切口均愈合良好,胸廓内动脉第5肋间穿支皮瓣全部成活,无溃疡、坏死等。10例均获随访,随访时间6~31个月,平均15个月。随访期间皮瓣色泽及外观较好,患者较为满意,患处瘢痕疙瘩和(或)瘢痕溃疡均未见复发,2例患者创面愈合后未坚持正规瘢痕防治治疗,随访见切口线形瘢痕增生。供区外观良好且均无功能障碍。结论带蒂胸廓内动脉第5肋间穿支皮瓣修复胸骨切开术后胸骨区瘢痕疙瘩和(或)瘢痕溃疡切除术后软组织缺损创面,临床效果较佳,术后无复发,患处色泽及外观较好,供区外观良好且无继发功能障碍。Objective To explore the feasibility and clinical efficacy of reconstruction of the soft tissue defect after keloidectomy and/or cicatricial ulcers excision caused by sternotomy with the 5th intercostal perforator flap of the internal thoracic artery.Methods From September 2016 to August 2023,10 patients with sternal keloids and/or sternal scar ulcers caused by sternotomy were treated in the Medical Centre of Burn Plastic Surgery and Wound Repair,the First Affiliated Hospital of Nanchang University.The soft tissue defect after resection reconstructed by the pedicled 5th intercostal perforator flap of the internal thoracic artery.The patients were 7 males and 3 females,aged 17-65 years,with an average age of 43 years.The history of sternal scar was 2-15 years,with an average of 5.5 years.And the sizes of sternal scars were 2.0 cm×6.5 cm-5.5 cm×10.0 cm.After admission,the patients firstly received surgery to remove sternal keloids and/or scar ulcers.The defects of soft tissue were found from 2.5 cm×7.0 cm to 6.0 cm×10.5 cm in size after surgery.Then one-stage reconstructive surgery were performed on all of the patients with a transposition of the pedicled 5th intercostal perforator flap of the internal thoracic artery.Flaps were harvested in surgery at 3.5 cm×7.5 cm-6.0 cm×11.0 cm in size.The donor sites of flaps were pulled and directly sutured.After the surgery,wound healing and flap survival were observed,through regular follow-ups at outpatient clinics,and via internet hospitals or WeChat reviews to monitor the colour and appearance of the flaps,recurrence of keloids and/or ulcers,the appearance of donor sites and the secondary dysfunction of surgery.Results All incisions healed well after surgery,and all the pedicled 5th intercostal perforator flaps of the internal thoracic artery survived.All 10 patients were included in the postoperative follow-up for a period of 6-31 months,with an average of 15 months.During follow-up,the colour and appearance of the flaps were found good,and the patients were satisf

关 键 词：瘢痕疙瘩 胸前创面 穿支皮瓣 胸廓内动脉 修复 显微外科手术 

分 类 号：R655[医药卫生—外科学]