多种特殊形式旋股外侧动脉降支穿支皮瓣修复腕部高压电烧伤创面的临床效果  

Clinical effects of various special forms of the descending branch of the lateral circumflex femoral artery perforator flaps in repairing high-voltage electrical burn wounds on the wrist

作　　者：杜伟力 熊枫 车可心 程琳 代强 沈余明 Du Weili;Xiong Feng;Che Kexin;Cheng Lin;Dai Qiang;Shen Yuming(Department of Burns,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院烧伤科,北京100035

出　　处：《中华烧伤与创面修复杂志》2025年第1期18-27,共10页Chinese Journal of Burns And Wounds

基　　金：国家重点研发计划(2018YFA0703104);首都卫生发展科研专项(首发2020-2-1123);北京市属医院科研培育计划(PX2024016);北京积水潭医院学科骨干(XKGG202209)。

摘　　要：目的探讨多种特殊形式旋股外侧动脉降支(DLCFA)穿支皮瓣修复腕部高压电烧伤创面的临床效果。方法该研究为回顾性观察性研究。2014年9月—2024年6月,首都医科大学附属北京积水潭医院收治符合入选标准的腕部高压电烧伤男性患者79例,其年龄为20~62岁,腕部高压电烧伤创面(下称腕部创面)分型为Ⅱ型或Ⅲ型。伤后早期,对患者腕部行清创术,根据创面情况及皮瓣适应证,单独采用血流桥接、分叶、嵌合、血流桥接-分叶、分叶-嵌合、血流桥接-嵌合、血流桥接-分叶-嵌合DLCFA穿支皮瓣或者联合采用血流桥接-嵌合DLCFA穿支皮瓣与阔筋膜张肌肌皮瓣修复创面。采用直接拉拢缝合或皮片移植方式修复供瓣区创面。记录术中切取各类DLCFA穿支皮瓣数及其修复的各型腕部创面数、供瓣区创面封闭情况,统计术后皮瓣成活情况、是否发生血管危象、创面或者缝合口愈合情况、血流桥接皮瓣重建动脉通畅情况。随访时,观察皮瓣外形、瘢痕形成情况,以及大腿肌疝发生情况。结果术中,切取11个血流桥接DLCFA穿支皮瓣修复11个Ⅱ型腕部创面,切取13个分叶DLCFA穿支皮瓣修复9个Ⅱ型和4个Ⅲ型腕部创面,切取16个嵌合DLCFA穿支皮瓣修复16个Ⅱ型腕部创面,切取11个血流桥接-分叶DLCFA穿支皮瓣修复5个Ⅱ型和6个Ⅲ型腕部创面,切取10个分叶-嵌合DLCFA穿支皮瓣修复5个Ⅱ型和5个Ⅲ型腕部创面,切取6个血流桥接-嵌合DLCFA穿支皮瓣修复6个Ⅱ型腕部创面,切取7个血流桥接-分叶-嵌合DLCFA穿支皮瓣修复7个Ⅲ型腕部创面,另切取5个血流桥接-嵌合DLCFA穿支皮瓣联合阔筋膜张肌肌皮瓣修复5个Ⅲ型腕部创面。74例患者供瓣区创面经直接缝合封闭,5例患者供瓣区创面经皮片移植封闭。术后,3例患者皮瓣发生血管危象,其中动脉危象1例、静脉危象2例,经急诊血管探查等处理后皮瓣成活;其余皮瓣完全成活。术�Objective To explore the clinical effects of various special forms of the descending branch of the lateral circumflex femoral artery(DLCFA)perforator flaps in repairing high-voltage electrical burn wounds on the wrist.MethodsThis study was a retrospective observational study.From September 2014 to June 2024,79 male patients with high-voltage electrical burns on the wrist,aged 20 to 62 years and met the inclusion criteria,were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University,with wrist high-voltage electrical burn wound(hereinafter referred to as wrist wound)types being classified as typeⅡor typeⅢ.In the early stage after injury,debridement was performed on the patients'wrists.Based on the wound condition and flap indications,the flow-through,lobed,chimeric,flow-through-lobed,lobed-chimeric,flow-through-chimeric,or flow-through-lobed-chimeric DLCFA perforator flap was employed individually,and the flow-through-chimeric DLCFA perforator flap and tensor fascia lata myocutaneous flap were employed in combination to repair the wounds.The donor site wounds were repaired using direct sutures or skin grafting.The number of various DLCFA perforator flaps resected during surgery and the number of various types of wrist wounds repaired were recorded,as well as the closure status of the donor site wound.The postoperative flap survival,occurrence of vascular crisis,wound or suture site healing,and patency of the reconstructed artery in flow-through flaps were recorded.During follow-up,the appearance of the flap,scar formation,and the presence of thigh muscle herniation were observed.ResultsIntraoperatively,11 flow-through DLCFA perforator flaps were resected to repair 11 typeⅡwrist wounds,13 lobed DLCFA perforator flaps were resected to repair 9 typeⅡand 4 typeⅢwrist wounds,16 chimeric DLCFA perforator flaps were resected to repair 16 typeⅡwrist wounds,11 flow-through-lobed DLCFA perforator flaps were resected to repair 5 typeⅡand 6 typeⅢwrist wounds,10 lobed-chimeric DLCFA perfo

关 键 词：烧伤 电 腕损伤 显微外科手术 外科皮瓣 旋股外侧动脉降支穿支皮瓣 血流桥接皮瓣 嵌合皮瓣 创面修复 

分 类 号：R65[医药卫生—外科学]