Clinical effects of bridge-type continuous negative pressure suction in postoperative fixation of upper limb soft tissue defect wound repaired with pedicled abdominal flap
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摘要:
目的 观察腹部带蒂皮瓣修复上肢软组织缺损创面术后应用桥梁式持续负压吸引固定的临床效果。 方法 采用回顾性观察性研究方法。2018年4月—2020年10月，空军军医大学第一附属医院收治95例符合入选标准的手部及前臂软组织缺损患者，其中男55例、女40例，年龄5~78岁，缺损创面面积为82（9，216）cm2，均行腹部带蒂皮瓣移植修复术。根据患者术区所采用固定方法的不同，将患者分为负压组48例和石膏组47例，2组患者损伤创面经清创后行皮瓣移植修复，负压组患者术后采用干纱布包扎后放置负压吸引装置以“桥梁”式固定缺损上肢与胸腹部，石膏组患者术后采用常规干纱布铺垫及石膏固定。术后1、3、5、7、14 d，采用自制血运评分量表和长海痛尺分别评估2组患者皮瓣血运和疼痛强度。术后5 d，观察并计算术区及其周围皮肤常见并发症发生率。术后7 d，进行患者满意度评分。断蒂术后1个月随访，观察患肢外观及功能恢复情况。对数据进行重复测量方差分析、独立样本t检验、Cochran & Cox近似t检验、χ2检验及Wilcoxon秩和检验。 结果 术后1、3、5、7、14 d，负压组患者的皮瓣血运评分变化不大，而石膏组患者的皮瓣血运评分呈时间依赖性下降，且负压组患者皮瓣血运评分均明显高于石膏组（t=2.259、2.552、2.784、2.821、3.003，P<0.05或P<0.01）；负压组患者的疼痛强度评分变化不大，而石膏组患者疼痛强度评分呈时间依赖性升高，且负压组患者疼痛强度评分均明显低于石膏组（t=-4.818、-4.944、-5.011、-5.976、-6.721，P<0.05）。术后5 d，负压组患者术区及其周围皮肤常见并发症发生率均明显低于石膏组（χ2=6.773、5.269，P<0.05或P<0.01）。术后7 d，负压组患者满意度评分为（14.7±1.1）分，明显高于石膏组的（7.4±1.8）分（t=23.934，P<0.01）。断蒂术后1个月随访，2组患者的患肢外观及功能恢复均良好。 结论 腹部带蒂皮瓣修复上肢软组织缺损创面后，进行桥梁式持续负压吸引固定能有效制动患肢与胸腹部，降低术区及其周围皮肤常见并发症发生率，减轻患者制动的疼痛，改善皮瓣血运，提高患者满意度，是一种行之有效、轻便舒适、易于操作的方法。 Abstract:Objective To observe the clinical effects of bridge-type continuous negative pressure suction in postoperative fixation of upper limb soft tissue defect wound repaired with pedicled abdominal flap. Methods The retrospective observational study was conducted. From April 2018 to October 2020, ninety-five patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 55 males and 40 females, aged 5-78 years, with a defect wound area of 82 (9, 216) cm2. All patients underwent abdominal flap repair for soft tissue defects of hand and forearm. According to the different fixation methods adopted in the operation area, the patients were divided into negative pressure group (n=48) and plaster group (n=47). Wounds of the injury sites of patients in the 2 groups were repaired by flap transplantation after debridement. The negative pressure suction device was placed after dry gauze dressing to form a "bridge" to fix the affected upper limb and chest and abdomen in negative pressure group. Patients in plaster group were treated with conventional dry gauze matting and plaster fixation. On post surgery day (PSD) 1, 3, 5, 7, and 14, flap blood circulation and pain intensity of patients in the 2 groups were calculated by self-made blood flow scoring scale and Changhai Pain Ruler, respectively. On PSD 5, the common complications in operative area and surrounding skin were observed and their incidences were calculated. On PSD 7, satisfaction degree of patients was scored. During follow-up of one month after pedicle division, the appearance and functional recovery of the affected limb were observed. Data were statistically analyzed with analysis of variance for repeated measurement, independent samples t est, Cochran & Cox approximate t test, chi-square test, and Wilcoxon rank-sum test. Results On PSD 1, 3, 5, 7, and 14, the flap blood circulation scores of patients in negative pressure group did not change significantly, while that of patients in plaster group showed a time-dependent decrease, and the flap blood circulation scores of patients in negative pressure group were significantly higher than those in plaster group (t=2.259, 2.552, 2.784, 2.821, 3.003, P<0.05 or P<0.01). There were no significant changes in the pain intensity scores of patients in negative pressure group, while those of patients in plaster group increased in a time-dependent manner, and the pain intensity scores of patients in negative pressure group were significantly lower than those in plaster group (t=-4.818, -4.944, -5.011, -5.976, -6.721, P<0.05). On PSD 5, the incidences of common complications in operative area and surrounding skin of patients in negative pressure group were significantly lower than those in plaster group (χ2=6.773, 5.269, P<0.05 or P<0.01). On PSD 7, the satisfaction score of patients in negative pressure group was 14.7±1.1, which was significantly higher than 7.4±1.8 in plaster group (t=23.934, P<0.01). During follow-up of one month after pedicle division, the appearance and function of the affected limb of patients in the 2 groups recovered well. Conclusions After repairing the upper limb soft tissue defect wound with pedicled abdominal flap, the bridge-type continuous negative-pressure suction fixation can effectively immobilize the affected limbs, chest and abdomen, reduce the incidence of common complications in the operative area and surrounding skin, relieve the pain of immobilization of patients, improve the blood circulation of flap and patient's satisfaction. Thus, it is an effective, portable, comfortable, and easy-to-operate method. -
参考文献
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1 负压组患者因电击伤致左手拇指、示指和中指缺损行腹部皮瓣移植修复术后采用桥梁式负压固定。1A.术前左手拇指、示指及中指部分肌腱及骨外露；1B.应用桥梁式持续负压吸引固定法固定上肢与胸腹部情况；1C.术后5 d换药时，皮瓣血运良好，未出现术区及周围皮肤常见并发症；1D、1E.分别为术后3周断蒂时腹部、左手术后即刻情况，皮瓣血运良好，未出现术区及周围皮肤常见并发症；1F.断蒂术后1个月随访，左手外观恢复良好
表1 2组上肢软组织缺损行腹部皮瓣移植修复术的患者一般资料比较
组别 例数 性别（例） 年龄［岁， 软组织缺损部位（例） 缺损创面面积［cm2，M（min，max）］ 男 女 手部 腕部 前臂 肘窝 负压组 48 29 19 23（5，78） 15 17 13 3 78（9，213） 石膏组 47 26 21 28（5，75） 21 14 10 2 80（9，216） 统计量值 χ2=0.342 Z=-0.365 χ2=0.185 Z=-1.703 P值 0.369 0.715 0.512 0.089 
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表2 2组上肢软组织缺损患者行腹部皮瓣移植修复术后不同时间点皮瓣血运评分的比较( 分，
组别 例数 术后1 d 术后3 d 术后5 d 术后7 d 术后14 d 负压组 48 3.92±0.07 3.89±0.09 3.89±0.09 3.79±0.12 3.78±0.12 石膏组 47 3.21±0.07 2.96±0.09 2.66±0.11 2.23±0.13 2.00±0.14 t值 2.259 2.552 2.784 2.821 3.003 P值 0.035 0.030 0.021 0.012 0.008 注：处理因素主效应，F=74.764，P<0.001；时间因素主效应，F=60.399，P<0.001；两者交互作用，F=27.229，P<0.001
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表3 2组上肢软组织缺损患者行腹部皮瓣移植修复术后不同时间点疼痛强度评分比较(分，
组别 例数 术后1 d 术后3 d 术后5 d 术后7 d 术后14 d 负压组 48 3.52±0.27 3.47±0.24 3.48±0.24 3.48±0.25 3.49±0.26 石膏组 47 4.60±0.25 5.64±0.34 5.78±0.44 6.87±0.44 7.25±0.59 t值 -4.818 -4.944 -5.011 -5.976 -6.721 P值 0.042 0.034 0.031 0.022 0.011 注：处理因素主效应，F=134.764，P<0.001；时间因素主效应，F=95.892，P<0.001；两者交互作用，F=76.281，P<0.001
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