基于彩色多普勒超声定位的分层削薄旋髂浅动脉穿支皮瓣的临床疗效  

Clinical efficacy of layered thinning superficial circumflex iliac artery perforator flap based on color Doppler ultrasound positioning

作　　者：张文桐[1] 杨勇 李峰 李斌 王丹丹 陈涛 李建峰[1] Zhang Wentong;Yang Yong;Li Feng;Li Bin;Wang Dandan;Chen Tao;Li Jianfeng(Department of Hand and Foot Surgery,Beijing Shunyi District Hospital,Beijing 101300,China;Department of Hand Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Department of Ultrasound Diagnosis,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]北京市顺义区医院手足外科,北京101300 [2]首都医科大学附属北京积水潭医院手外科,北京100035 [3]首都医科大学附属北京积水潭医院超声诊断科,北京100035

出　　处：《中华烧伤与创面修复杂志》2025年第1期45-52,共8页Chinese Journal of Burns And Wounds

基　　金：北京市卫生系统高层次卫生技术人才培养计划(2015-3-036);北京市医院管理中心“登峰”人才培养计划(DFL20240402)。

摘　　要：目的探讨基于彩色多普勒超声(CDU)定位的分层削薄旋髂浅动脉穿支(SCIP)皮瓣的临床疗效。方法该研究为回顾性观察性研究。2023年2月—2024年2月,首都医科大学附属北京积水潭医院手外科收治符合入选标准的肢体创面患者14例,其中男11例、女3例,年龄15~60岁,创面面积为7 cm×4 cm~14 cm×11 cm。皮瓣移植术前应用CDU准确定位旋髂浅动脉浅支的深筋膜穿出点,术中分层削薄SCIP皮瓣,修复11例患者的手部、前臂创面和3例患者的足部创面,皮瓣切取面积为8 cm×5 cm~15 cm×12 cm。将皮瓣供区创面直接缝合。术中观察皮瓣供区内旋髂浅动脉浅支的深筋膜穿出点,并与术前CDU定位情况进行比对;测量皮瓣厚度。术后观察皮瓣成活情况及不良反应发生情况。随访时,观察皮瓣外观和质地、供区创面愈合情况。末次随访时,按照中华医学会手外科学会上肢部分功能评定试用标准对患肢腕、手功能进行评价,按照美国矫形足踝协会评分标准对患肢足踝功能进行评价。结果术中观察到所有皮瓣供区内旋髂浅动脉浅支的深筋膜穿出点与术前CDU定位一致,二者距离均<10 mm;皮瓣厚度为5~8 mm,平均6.2 mm。术后皮瓣均成活。随访5~12个月,所有皮瓣外观和质地良好;供区创面均愈合,仅遗留线性瘢痕。末次随访时,患肢腕、手功能评定为优者9例、良者1例、可者1例;患肢足踝功能评定为优者1例、良者2例。结论CDU检查能够为分层削薄SCIP皮瓣提供术前精确的穿支定位,有助于优化皮瓣设计,从而在一定程度上避免因术前设计不当导致的皮瓣坏死问题,提升手术安全性。此外,分层削薄SCIP皮瓣对供区的损伤较小,有利于患肢功能的恢复,值得临床推广。Objective To explore the clinical efficacy of layered thinning superficial circumflex iliac artery perforator(SCIP)flap based on color Doppler ultrasound(CDU)positioning.MethodsThe study was a retrospective observational study.From February 2023 to February 2024,14 patients who met the inclusion criteria were admitted to the Department of Hand Surgery of Beijing Jishuitan Hospital Affiliated to Capital Medical University,including 11 males and 3 females,aged 15 to 60 years.The wound area was from 7 cm×4 cm to 14 cm×11 cm.Before the flap transplantation surgery,CDU was used to accurately locate the deep fascial exit point of the superficial branch of the superficial circumflex iliac artery.During the surgery,the SCIP flap was thinned in layers to repair the hand and forearm wounds of 11 patients and foot wounds of 3 patients.The flap incision area ranged from 8 cm×5 cm to 15 cm×12 cm.The donor area wounds of flaps were sutured directly.During the surgery,the deep fascial exit point of the superficial branch of the superficial circumflex iliac artery in the flap donor area was observed and compared with the result of CDU positioning before the surgery,and the flap thickness was measured.The flap survival and occurrence of adverse reactions were observed after the surgery.During follow-up,the appearance and texture of flaps,and the wound healing in the donor area was observed.At the last follow-up,the function of the wrist and hand in the affected limbs was evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association,and the function of the foot and ankle in the affected limbs was evaluated according to the scoring standard of American Orthopaedic Foot and Ankle Society.ResultsDuring the surgery,the deep fascial exit point of the superficial branch of the superficial circumflex iliac artery in the flap donor area was consistent with the result of CDU positioning before the surgery,and the distance between them was less

关 键 词：外科皮瓣 穿支皮瓣 显微外科手术 超声检查 多普勒 彩色 旋髂浅动脉 创面修复 

分 类 号：R44[医药卫生—诊断学]