分叶腹股沟皮瓣游离移植的临床应用效果  

Clinical application effects of free transplantation of lobulated inguinal flaps

作　　者：张伟 张卫东 徐军辉 陈斓 龚翔 刘峰 周锦秀 杨飞 谢卫国 Zhang Wei;Zhang Weidong;Xu Junhui;Chen Lan;Gong Xiang;Liu Feng;Zhou Jinxiu;Yang Fei;Xie Weiguo(Department of Burns,Tongren Hospital of Wuhan University&Wuhan Third Hospital,Wuhan 430060,China)

机构地区：[1]武汉大学同仁医院暨武汉市第三医院烧伤科,武汉430060

出　　处：《中华烧伤与创面修复杂志》2025年第1期36-44,共9页Chinese Journal of Burns And Wounds

基　　金：湖北省自然科学基金(2024AFB470);武汉市知识创新专项曙光计划项目(2022020801020553);武汉市临床医学科研项目(WX23Q11)。

摘　　要：目的探讨分叶腹股沟皮瓣游离移植的临床应用效果。方法该研究为回顾性观察性研究。2019年7月—2024年4月,武汉大学同仁医院暨武汉市第三医院收治有1个部位创面符合入选标准的34例皮肤缺损创面患者,其中男28例、女6例,年龄26~59岁,受区创面面积为3.0 cm×2.0 cm~25.0 cm×20.0 cm。对19例患者行以旋髂浅动脉的分支为蒂分叶的腹股沟皮瓣切取,对15例患者行以旋髂浅动脉和腹壁浅动脉主干为蒂分叶的腹股沟皮瓣切取,皮瓣总面积为6.0 cm×2.2 cm~27.0 cm×23.0 cm。将皮瓣分成2~4叶,各个分叶面积为2.0 cm×1.0 cm~17.0 cm×12.0 cm。将皮瓣各个分叶重新组合、拼接或直接移植于创面,将供区创面分层缝合。术后观察皮瓣分叶成活情况、受供区创面愈合情况,随访受供区创面恢复情况。末次随访时,采用利克特5级量表评价患者对疗效的满意度。结果术后4例患者均有1个皮瓣分叶的尖端出现少量坏死,经修整后愈合;其余30例患者的皮瓣成活。受区创面均顺利愈合。3例患者的供区缝合口边缘出现少量坏死,经局部修整+换药后愈合;其余31例患者的供区创面愈合良好。随访6~42个月,受区均恢复良好,供区外形良好。末次随访时,患者中对疗效非常满意者15例、比较满意者15例、一般满意者4例。结论通过术前超声检查定位,根据血管走行设计腹股沟皮瓣,以旋髂浅动脉的分支为蒂进行皮瓣分叶或以旋髂浅动脉和腹壁浅动脉主干为蒂进行皮瓣分叶,其解剖过程可靠,分叶后的皮瓣血运丰富,可满足各类皮肤缺损创面的修复需求,且修复效果较佳,供区损伤小,值得推广。Objective To investigate the clinical application effects of free transplantation of lobulated inguinal flaps.MethodsThis study was a retrospective observational study.From July 2019 to April 2024,34 patients with skin defect wounds whose wounds in one part met the inclusion criteria were admitted to Tongren Hospital of Wuhan University&Wuhan Third Hospital,including 28 males and 6 females,aged 26 to 59 years.The wound area in the recipient area ranged from 3.0 cm×2.0 cm to 25.0 cm×20.0 cm.The lobulated inguinal flap pedicled with the branch of the superficial circumflex iliac artery were obtained in 19 patients,and the lobulated inguinal flap pedicled with the main artery of the superficial circumflex iliac artery and the superficial inferior epigastric artery were obtained in 15 patients.The total area of the flaps ranged from 6.0 cm×2.2 cm to 27.0 cm×23.0 cm.The flaps were divided into 2 to 4 lobes,and the area of each lobe ranged from 2.0 cm×1.0 cm to 17.0 cm×12.0 cm.Each lobe of the flaps was reassembled,spliced,or directly transplanted onto the wounds,and the donor wounds were sutured in layers.The survival of each lobe of the flaps and wound healing in the recipient and donor areas were observed,and the wound recovery in the recipient and donor areas were followed up.At the last follow-up,the patient's satisfaction with the efficacy was assessed by 5-grade Likert scale.ResultsA small amount of necrosis appeared in the tip of one lobe of the flaps in 4 patients after surgery,which healed after trimming.The flaps of the remaining 30 patients survived.The wounds in the recipient areas healed smoothly.There was a small amount of necrosis at the suture edge of the donor areas in 3 patients,which healed after local trimming and dressing change.The donor wounds healed well in the remaining 31 patients.During the follow-up of 6 to 42 months,all the recipient wounds were well repaired,and the shape of the donor areas was good.At the last follow-up,15 patients were very satisfied with the efficacy,15 were rela

关 键 词：穿支皮瓣 显微外科手术 动静脉吻合 修复外科手术 软组织损伤 瘢痕 烧伤 癌 鳞状细胞 创面修复 

分 类 号：R65[医药卫生—外科学]