基于供区保护理念的游离股前外侧分叶穿支皮瓣在头部电烧伤创面修复中的临床应用效果

郭鹏飞; 王旭; 魏爱周; 孟庆楠; 周健; 高娅; 崔正军

doi:10.3760/cma.j.cn501120-20201111-00470

基于供区保护理念的游离股前外侧分叶穿支皮瓣在头部电烧伤创面修复中的临床应用效果

doi: 10.3760/cma.j.cn501120-20201111-00470

郑州大学第一附属医院烧伤与修复重建外科，郑州　　450052

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崔正军，Email：157856800@qq.com

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- 收稿日期: 2020-11-11

Effects of clinical application of free anterolateral thigh perforator lobulated flap in repair of electrical burn wounds on head based on the concept of donor site protection

Department of Burns and Reconstructive Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

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Corresponding author: Cui Zhengjun, Email: 157856800@qq.com

摘要

摘要: 目的探讨基于供区保护理念的游离股前外侧分叶穿支皮瓣在头部电烧伤创面修复中的临床应用效果。方法采用回顾性观察性研究方法。2017年5月—2019年12月，郑州大学第一附属医院收治8例符合入选标准的头皮巨大缺损伴颅骨外露的电烧伤患者，均为男性，年龄21~57（39±13）岁，全身多处伴深Ⅱ~Ⅳ度电烧伤，烧伤总面积为5%~14%体表总面积。患者头皮烧伤受损部位中，后枕部1例、顶枕部2例、颞顶部4例、额颞部1例；扩创后缺损面积为10 cm×9 cm~16 cm×14 cm，游离股前外侧分叶穿支皮瓣切取面积为22 cm×6 cm~30 cm×9 cm。皮瓣的动静脉与受区颞浅动静脉或面动静脉吻合，皮瓣另一条静脉与受区浅表静脉吻合。皮瓣供区间断分层减张缝合。术后观察患者皮瓣成活情况、供区愈合及并发症发生情况。随访观察患者皮瓣外观，供瓣区愈合质量、是否有远期并发症及功能恢复情况。结果 8例患者术后皮瓣完全成活，未发生血管危象；供区愈合良好，未见骨筋膜隔室综合征发生。7例患者随访3~12个月，1例失访。随访患者头部皮瓣外形良好，但存在秃发；供区可见线性瘢痕，位置隐蔽，感觉及运动功能与对侧无明显差异，未见肌疝等并发症发生。结论游离股前外侧分叶穿支皮瓣对头皮巨大缺损伴颅骨外露的头部电烧伤创面的早期修复具有较好临床效果，同时供区可以直接拉拢缝合，大大减少了对供区的损伤。
- 烧伤，电 /
- 外科皮瓣 /
- 供区保护 /
- 头皮缺损 /
- 颅骨外露
Abstract: Objective To explore the effects of clinical application of free anterolateral thigh perforator lobulated flap in repair of electrical burn wounds on head based on the concept of donor site protection. Methods A retrospective observational study was conducted. Eight patients with electrical burns with huge scalp defects and exposed skulls were admitted to the First Affiliated Hospital of Zhengzhou University, from May 2017 to December 2019, who were all males, aged 21-57 (39±13) years, sustaining multiple deep partial thickness to full-thickness electrical burns to 5%-14% total body surface area. Among the scalp burn sites of the patients, 1 case was posterior occipital, 2 cases were parietal occipital, 4 cases were parietal temporal, and 1 case was frontotemporal. After debridement, the defect area was 10 cm×9 cm-16 cm×14 cm. The incision area of the free anterolateral thigh perforator lobulated flap was 22 cm×6 cm-30 cm×9 cm. The artery and vein of flap were anastomosed with superficial temporal artery and vein or facial artery and vein, and the other vein of skin flap was anastomosed with superficial vein of recipient area. The donor site of skin flap was closed by layer interrupted tension-reducing suture. After the operation, the survival of flop, donor site wound healing and complications were observed. The flap appearance, wound healing of donor sites, long-term complications and functional recovery of donor sites were observed on follow-up. Results After the operation, the flaps of 8 patients survived completely without vascular crisis. The donor sites of flaps in all the patients healed well with no osteofascial compartment syndrome. Seven patients were followed up for 3 to 12 months, and 1 case was lost to follow up. During follow-up, the flaps of the patients' heads were in good appearance but with alopecia. The donor sites showed linear scars, which were well hidden. There were no significant differences in sensory and motor functions between the two sides, and no complications were found such as muscle hernia. Conclusions Free anterolateral thigh perforator lobulated flap has a good clinical effect in the early repair of electrical burn wounds with huge scalp defect and skull exposure on head, and the donor wounds can be directly closed and sutured, greatly reducing the damage to the donor area.
- Burns, electric /
- Surgical flaps /
- Donor protection /
- Scalp defect /
- Skull exposure
所有作者均声明不存在利益冲突

高光谱成像是一种新的非接触式测量方法。该研究借助高光谱成像可清楚评估创面灌注的特性，利用数据处理来计算成年人烧伤创面三维灌注参数，可估算6种(1、2、3A、3B、4、5)不同损伤皮肤层面的血红蛋白的体积分数和氧合参数，描述热损伤后72 h内烧伤创面的微循环情况，反映烧伤皮肤的损伤深度。研究通过比较不同程度的创面测量结果，分析不同深度创面的特征和差异，形成了用于烧伤创面深度诊断的三维灌注分析方法。综上，该研究基于对这种灌注特性的分析，开发出了一种新的、更可靠的烧伤深度诊断技术，有助于指导外科医师尽早选择最佳创面治疗方案。

王双,编译自《Burns》, 2021,47(1):157-170;申传安,审校

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1 游离股前外侧分叶穿支皮瓣修复患者后枕部头皮巨大缺损伴颅骨外露高压电烧伤创面。1A.术中扩创后创面情况；1B.术中根据创面缺损大小及穿支血管位置设计分叶皮瓣；1C. 分叶穿支皮瓣重新组合后与颞浅动静脉吻合；1D.游离皮瓣移植封闭创面即刻；1E.创面修复术后4个月随访，皮瓣存活良好；1F.术后1年随访，供区愈合良好，可见线性瘢痕

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