双蒂腹壁下动脉穿支皮瓣修复下肢大面积软组织缺损的疗效

黄宇 黄波 刘安铭 唐林 周鑫 王韶亮 邹永根

黄宇, 黄波, 刘安铭, 等. 双蒂腹壁下动脉穿支皮瓣修复下肢大面积软组织缺损的疗效[J]. 中华烧伤与创面修复杂志, 2023, 39(6): 540-545. DOI: 10.3760/cma.j.cn501225-20220831-00373.
引用本文: 黄宇, 黄波, 刘安铭, 等. 双蒂腹壁下动脉穿支皮瓣修复下肢大面积软组织缺损的疗效[J]. 中华烧伤与创面修复杂志, 2023, 39(6): 540-545. DOI: 10.3760/cma.j.cn501225-20220831-00373.
Huang Y,Huang B,Liu AM,et al.Curative effects of bi-pedicled deep inferior epigastric perforator flap in repairing large soft tissue defects in the lower limbs[J].Chin J Burns Wounds,2023,39(6):540-545.DOI: 10.3760/cma.j.cn501225-20220831-00373.
Citation: Huang Y,Huang B,Liu AM,et al.Curative effects of bi-pedicled deep inferior epigastric perforator flap in repairing large soft tissue defects in the lower limbs[J].Chin J Burns Wounds,2023,39(6):540-545.DOI: 10.3760/cma.j.cn501225-20220831-00373.

双蒂腹壁下动脉穿支皮瓣修复下肢大面积软组织缺损的疗效

doi: 10.3760/cma.j.cn501225-20220831-00373
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    通讯作者:

    黄波,Email:Huangbo19860622@163.com

Curative effects of bi-pedicled deep inferior epigastric perforator flap in repairing large soft tissue defects in the lower limbs

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  • 摘要:   目的   探讨双蒂腹壁下动脉穿支皮瓣修复下肢大面积软组织缺损的疗效。   方法   采用回顾性观察性研究方法。2016年2月—2020年6月,西南医科大学附属中医医院手外科收治因外伤所致或肿瘤/瘢痕切除后下肢大面积软组织缺损患者16例,其中男9例、女7例,年龄25~58岁,软组织缺损面积为14.0 cm×8.0 cm~32.0 cm×18.0 cm。以腹部为供区,设计并切取腹壁联体皮瓣——携带两侧腹壁下动脉主干的双蒂腹壁下动脉穿支皮瓣(面积为15.0 cm×9.0 cm~32.0 cm×20.0 cm)修复创面。将供区创面直接缝合。术后观察皮瓣成活情况、供受区创面愈合情况,随访评估疗效,末次随访时分别根据美国膝关节协会评分与下肢功能量表评估膝关节和小腿功能。   结果   15例患者术后皮瓣成活;1例患者术后皮瓣边缘部分感染,经清创换药后愈合。16例患者供受区创面均愈合良好。随访16~28个月显示,受区外形较好,质地柔软,未出现明显外观臃肿、色素明显沉着或异常毛发生长等;供区仅遗留线性瘢痕,未出现腹壁疝或瘢痕增生等并发症;膝关节及小腿功能重建较好,未见肿瘤复发。末次随访时,4例膝关节损伤患者膝关节功能评估中,优者3例、良者1例;12例小腿损伤患者小腿功能评估中,优者9例、良者3例。   结论   双蒂腹壁下动脉穿支皮瓣供区隐蔽、组织量丰富、切取面积大,用其修复下肢大面积软组织缺损可获得较佳的近期外观与功能恢复效果。

     

  • 1  双蒂腹壁下动脉穿支皮瓣修复例1患者右膝瘢痕癌变(鳞状细胞癌)组织切除后创面的效果。1A.入院时右膝瘢痕挛缩;1B、1C.分别为肿瘤根治性切除后即刻创面侧面观、后面观;1D.术中皮瓣设计;1E.皮瓣血管蒂与受区血管吻合后即刻;1F.受区术后即刻;1G、1H.分别为术后20个月随访受区、供区外观,受区外形自然,供区遗留线性瘢痕

    2  双蒂腹壁下动脉穿支皮瓣修复例2交通事故致脱套伤患者左小腿后侧软组织缺损创面。2A.入院时左小腿后方大片软组织缺损;2B.术中皮瓣设计;2C.皮瓣断蒂前;2D.携带双侧腹壁下动脉主干,制备血流桥接皮瓣;2E、2F.分别为受区、供区术后即刻;2G、2H.分别为术后22个月受区、供区外观,受区略显臃肿,供区遗留线性瘢痕

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  • 收稿日期:  2022-08-31

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