自行设计改良菱形皮瓣在面部创面修复中的临床疗效观察

易磊; 窦懿; 周增丁; 李学川; 郑捷新; 张勤; 郇京宁; 刘琰

doi:10.3760/cma.j.cn501120-20200504-00250

自行设计改良菱形皮瓣在面部创面修复中的临床疗效观察

doi: 10.3760/cma.j.cn501120-20200504-00250

上海交通大学医学院附属瑞金医院灼伤整形科　　200025

基金项目:

国家自然科学基金面上项目 81971832

上海市自然科学基金 19ZR1432100, 21ZR1440600

上海市临床重点专科项目 shslczdzk02302

详细信息

通讯作者:
刘琰，Email：rjliuyan@126.com

计量
- 文章访问数: 311
- HTML全文浏览量: 306
- PDF下载量: 30
- 被引次数: 0
出版历程
- 收稿日期: 2020-05-04

Observation on the clinical effect of self-designed modified rhomboid skin flap in facial wound repair

Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Funds:

General Program of National Natural Science Foundation of China 81971832

Natural Science Foundation of Shanghai of China 19ZR1432100, 21ZR1440600

Shanghai Key Clinical Specialty Project Fund of China shslczdzk02302

More Information

Corresponding author: Liu Yan, Email: rjliuyan@126.com

摘要

摘要: 目的探讨自行设计改良菱形皮瓣修复面部菱形、圆形及泪滴形创面的临床疗效。方法采用回顾性观察性研究方法。2018年8月—2020年4月，上海交通大学医学院附属瑞金医院及云南省剑川县人民医院接诊符合入选标准的30例面部病损患者，其中男16例、女14例，年龄23~88岁。患者创面面积为1.0 cm×1.0 cm~7.0 cm×5.0 cm，其中菱形创面10例、圆形创面12例、泪滴形创面8例，均采用自行设计改良菱形皮瓣修复。术后随访1~18个月，记录患者皮瓣成活情况、创面张力情况、术后瘢痕情况及并发症。结果术后皮瓣尖端无坏死发黑，皮瓣均成活，创面张力小、愈合良好，瘢痕增生不明显，无并发症。结论自行设计改良菱形皮瓣尤其适合存在多个重要器官、多个解剖亚单位及软组织张力区变化较大的面部创面，不仅可减少皮瓣旋转推进幅度，而且可减少不必要的正常皮肤软组织切除。
- 外科皮瓣 /
- 伤口愈合 /
- 菱形创面 /
- 圆形创面 /
- 泪滴形创面
Abstract: Objective To investigate the clinical effect of self-designed modified rhomboid flap in repairing rhomboid, round, and teardrop-shaped wounds on the face. Methods A retrospective observational study was conducted. From August 2018 to April 2020, 30 patients with facial lesions admitted into Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the People's Hospital of Jianchuan County in Yunnan province met the inclusion criteria, including 16 males and 14 females, aged 23 to 88 years. The wound area ranged from 1.0 cm×1.0 cm to 7.0 cm×5.0 cm, with 10 cases of rhomboid wounds, 12 cases of round wounds, and 8 cases of teardrop-shaped wounds. The self-designed modified rhomboid flaps were applied to repair the wounds and after that, the patients were followed up for 1 to 18 months to record the survival of flaps, wound tension, scar formation and complications after surgery. Results No necrosis or blackening was observed at the tip of the flaps after surgery. All the flaps survived and the wounds healed well with little tension, minimal scars, and no complications. Conclusions The self-designed modified rhomboid flap is especially suitable for facial wounds with multiple important organs, multiple anatomical subunits, and areas with large changes in soft tissue tension, which can reduce not only the rotation of the flap, but also unnecessary excision of normal skin and soft tissue.
- Surgical flaps /
- Wound healing /
- Rhomboid wound /
- Round wound /
- Teardrop-shaped wound
所有作者均声明不存在利益冲突

广告目次

苏州汇涵医用科技发展有限公司 ……………………………………………………………………………………… 插页1

上海铠唏尔医疗器械贸易有限公司 …………………………………………………………………………………… 插页2

南海朗肽制药有限公司 ………………………………………………………………………………………… 对中文目次1

江西省科星生物工程有限公司 ………………………………………………………………………………… 对中文目次2

上海腾瑞制药股份有限公司 …………………………………………………………………………………… 对英文目次1

保赫曼（上海）贸易有限公司 …………………………………………………………………………………… 对英文目次2

浙江医学科技开发有限公司 …………………………………………………………………………………………… 插页4

苏州爱得科技发展股份有限公司 ……………………………………………………………………………………… 对正文

珠海亿胜生物制药有限公司 ……………………………………………………………………………………………… 封三

武汉维斯第医用科技股份有限公司 ……………………………………………………………………………………… 封底

HTML全文

参考文献(12)

[1]	张杰.经皮肤梭形切口切除皮下良性肿物的观察[J].中国继续医学教育,2019,11(2):103-105.DOI: 10.3969/j.issn.1674-9308.2019.02.048.
[2]	曾开达,姚振晟,展望.局部皮瓣在修复面部软组织缺损中的应用[J].中华显微外科杂志,2018,41(5):509-511.DOI: 10.3760/cma.j.issn.1001-2036.2018.05.027.
[3]	JervisW,SalyerKE,BusquetsMA,et al.Further applications of the Limberg and Dufourmentel flaps[J].Plast Reconstr Surg,1974,54(3):335-340.DOI: 10.1097/00006534-197409000-00012.
[4]	ListerGD,GibsonT.Closure of rhomboid skin defects: the flaps of Limberg and Dufourmentel[J].Br J Plast Surg,1972,25(3):300-314.DOI: 10.1016/s0007-1226(72)80067-5.
[5]	李仔儒,慕森.菱形皮瓣在面部肿瘤切除中的应用[J].实用皮肤病学杂志,2016,9(3):199-201.DOI: 10.11786/sypfbxzz.1674-1293.20160312.
[6]	ImafukuK,HataH,YamaguchiY,et al.Modified Dufourmentel flap, easy to design and tailor to the defect[J].J Dermatol,2017,44(1):68-70.DOI: 10.1111/1346-8138.13568.
[7]	LeeKS, KimJO, KimNG, et al. A comparison of the local flap and skin graft by location of face in reconstruction after resection of facial skin cancer[J]. Arch Craniofac Surg, 2017, 18(4): 255-260. DOI: 10.7181/acfs.2017.18.4.255.
[8]	HungMH, LiaoCT, KangCJ,et al. Local rhomboid flap reconstruction for skin defects after excising large parotid gland tumors[J]. J Oral Maxillofac Surg, 2017,75(1):225.e1-225.e5. DOI: 10.1016/j.joms.2016.09.021.
[9]	MathewJ,VargheseS,JagadeeshS.The Limberg flap for cutaneous defects - a two year experience[J].Indian J Surg,2007,69(5):184-186.DOI: 10.1007/s12262-007-0017-1.
[10]	庄淑波,及跃男,赵娜,等.改良Dufoumental菱形皮瓣结合美学原理修复面部皮肤缺损[J].中国美容医学,2018,27(9):49-51.
[11]	张健,赵丽娜,蔡丽萍,等.局部皮瓣在头面部皮肤肿瘤切除后皮肤缺损中的应用[J].中国美容整形外科杂志,2011,22(5):288-290.DOI: 10.3969/j.issn.1673-7040.2011.05.011.
[12]	曹树英,张菊芳,沈海燕,等.对偶菱形皮瓣在颜面部特殊部位圆形缺损修复中的应用[J].浙江医学,2010,32(6):910-911.DOI: 10.3969/j.issn.1006-2785.2010.06.049.

1 自行设计改良菱形皮瓣的设计示意图。1A.类菱形创面，ABCD切除区创面为菱形，AB’C’D’为皮瓣区；1B.圆形创面，ABCD切除区创面为圆形，B’EF为皮瓣区；1C.泪滴形创面，ABCD切除区创面为泪滴形，AB’D’C’为皮瓣区

下载: 全尺寸图片幻灯片

2 应用自行设计改良菱形皮瓣修复例1患者面部菱形创面。2A.术前右侧面颊部类椭圆形病损；2B.根据标准菱形创面修复方案设计皮瓣并标记；2C.改良菱形皮瓣修复菱形创面后即刻张力适中，皮瓣血运可；2D.术后3个月随访，创面愈合良好，无下眼睑外翻等并发症

下载: 全尺寸图片幻灯片

3 应用自行设计改良菱形皮瓣修复例2患者面部泪滴形创面。3A.术前左眉区泪滴形病损；3B.根据泪滴形创面修复方案设计皮瓣并标记；3C.改良菱形皮瓣修复泪滴形创面后即刻张力适中，皮瓣血运可；3D.术后3个月随访，创面愈合良好

下载: 全尺寸图片幻灯片

4 应用自行设计改良菱形皮瓣修复例3患者面部圆形创面。4A.术前右侧面部圆形病损并明显突出体表；4B.根据圆形创面修复方案设计皮瓣并标记；4C.改良菱形皮瓣修复圆形创面后即刻张力适中，皮瓣血运可；4D.术后3个月随访，创面愈合良好，手术瘢痕线位于鱼尾纹及表情纹内

下载: 全尺寸图片幻灯片