扩张髂腹股沟皮瓣游离移植整复大面积烧伤后严重瘢痕挛缩畸形的临床效果

陈斓; 张伟; 谢卫国; 杨飞; 李泽

doi:10.3760/cma.j.cn501225-20220210-00021

扩张髂腹股沟皮瓣游离移植整复大面积烧伤后严重瘢痕挛缩畸形的临床效果

doi: 10.3760/cma.j.cn501225-20220210-00021

武汉大学同仁医院暨武汉市第三医院烧伤科，武汉　　430060

基金项目:

湖北省卫生健康科研基金 WJ2019H433

武汉市临床医学科研项目 WX17A03, WX11A04

武汉市医学科研项目 WG19B02

详细信息

通讯作者:
张伟，Email：zhw010@163.com

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出版历程
- 收稿日期: 2022-02-10

Clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture deformity after extensive burns

Department of Burns, Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, Wuhan 430060, China

Funds:

Scientific Research Project of Health Commission of Hubei Province of China WJ2019H433

Clinical Medical Research Project of Wuhan WX17A03, WX11A04

Medical Research Project of Wuhan WG19B02

More Information

Corresponding author: Zhang Wei, Email: zhw010@163.com

摘要

摘要: 目的探讨扩张髂腹股沟皮瓣游离移植整复大面积烧伤后严重瘢痕挛缩畸形的临床效果。方法采用回顾性观察性研究方法。2017年8月—2021年10月，武汉大学同仁医院暨武汉市第三医院收治7例大面积烧伤后严重瘢痕挛缩畸形患者，其中男5例、女2例，年龄26~65岁，瘢痕面积20 cm×4 cm~34 cm×14 cm。Ⅰ期于腹股沟韧带上方埋置额定容量为500~600 mL长方形皮肤软组织扩张器（以下简称扩张器），拆线后注射生理盐水扩张以满足修复手术需求。Ⅱ期手术切除瘢痕，矫正畸形，松解粘连及挛缩；取出扩张器后切取扩张髂腹股沟游离皮瓣，需较大皮瓣时联合切取脐旁穿支皮瓣，将皮瓣移植于瘢痕切除后继发创面。观察并记录扩张器埋置个数、注射生理盐水总量、扩张时间，皮肤软组织扩张术并发症发生情况，切取扩张髂腹股沟皮瓣个数、面积、厚度、吻合血管蒂，采用皮瓣类型，供瓣区修复方法，术后皮瓣成活情况。随访远期修复效果及供区情况，于末次随访时参照李克特量表5级评分调查患者对每个手术部位的疗效满意度。结果 7例患者共埋置10个扩张器，其中4例患者各埋置1个，3例患者各埋置2个。注射生理盐水总量为800~1 800（1 342±385）mL，扩张时间为4~24（11±5）个月。1例患者置入扩张器后因感染致扩张器外露，其余患者未发生皮肤软组织扩张术并发症。切取扩张髂腹股沟皮瓣个数为10个，面积为22 cm×6 cm~36 cm×16 cm［（326±132）cm²］，厚度为0.6~1.1（0.77±0.16）cm。10个扩张髂腹股沟皮瓣中，5个以旋髂浅动脉为蒂，3个以口径相对较大的腹壁浅动脉为蒂，1个以旋髂浅动脉和腹壁浅动脉共干为蒂，1个皮瓣吻合旋髂浅动脉的同时桥接腹壁浅动脉做动脉内增压。4例患者联合切取单侧扩张髂腹股沟皮瓣与同侧脐旁穿支皮瓣，1例患者联合切取双侧扩张髂腹股沟皮瓣，2例患者仅切取单侧扩张髂腹股沟皮瓣。除1例患者联合切取双侧扩张髂腹股沟皮瓣后供瓣区移植自体刃厚头皮修复外，其余患者供瓣区均直接缝合。术后皮瓣全部成活，无尖端坏死，无创面残留。随访3~30（15±10）个月，皮瓣质地柔软且不臃肿，受区功能、外观均较术前有明显改善，供区外观良好。末次随访时，患者对手术部位治疗效果的满意度评分为4~5（4.5±0.4）分。结论扩张髂腹股沟皮瓣可获取面积大，具有血运丰富、供区损伤小、位置隐蔽、便于联合脐旁穿支皮瓣切取移植等优势，适合用于大面积烧伤后严重瘢痕挛缩畸形的临床整复治疗。
- 烧伤 /
- 瘢痕 /
- 挛缩 /
- 扩张术 /
- 外科皮瓣 /
- 游离皮瓣 /
- 髂腹股沟区
Abstract: Objective To investigate the clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture after extensive burns. Methods A retrospective observational study was conducted. From August 2017 to October 2021, 7 patients with severe scar contracture deformity caused by extensive burns were hospitalized in Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, including 5 males and 2 females, aged 26-65 years, with scar area of 20 cm×4 cm-34 cm×14 cm. In the first stage, the rectangular skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 500-600 mL were embedded above the inguinal ligament, and then normal saline was injected after stitch removal for expansion to meet the needs of repair surgery. In the second stage, the scar was removed by surgical excision to correct the deformity and release the adhesion and contracture; after the removal of the expanders, the expanded ilioinguinal free flaps were harvested. When a larger flap was needed, the paraumbilical perforator flap was harvested at the same time, and the flaps were transplanted to the secondary wound after scar resection. The number of embedded expanders, the total amount of injected normal saline, the expansion time, the complications of skin and soft tissue expansion, the number, area, thickness, and anastomotic vascular pedicles of the expanded ilioinguinal flaps being resected, the type of flaps used, the repair method of flap donor sites, and the survival of flaps after operation were observed and recorded. The long-term repair effect and donor site condition were followed up. At the last follow-up, the patients' satisfaction with the curative effect of each surgical site was investigated according to the grade 5 score of Likert scale. Results A total of 10 expanders were embedded in 7 patients, of which 4 patients had 1 each and 3 patients had 2 each. The total volume of normal saline injected was 800-1 800 (1 342±385) mL, and the expansion time was 4-24 (11±5) months. One patient had the expander exposed due to infection after the expander being inserted, while the other patients had no complications of skin and soft tissue expansion. Totally 10 expanded ilioinguinal flaps with the area of 22 cm×6 cm-36 cm×16 cm ((326±132) cm²) and the thickness of 0.6-1.1 (0.77±0.16) cm were harvested. Among the 10 expanded ilioinguinal flaps, 5 were pedicled with the superficial circumflex iliac artery, 3 with the superficial abdominal artery with relatively large caliber, 1 with the common trunk of the superficial circumflex iliac artery and the superficial abdominal artery, and 1 flap was anastomosed with the superficial circumflex iliac artery and bridged the superficial abdominal artery for intra-arterial supercharge. Unilateral expanded ilioinguinal flap combined with ipsilateral paraumbilical perforator flap were harvested in 4 cases, bilateral expanded ilioinguinal flaps were harvested in 1 case, and unilateral expanded ilioinguinal flap was harvested in 2 cases. Except for 1 case being transplanted with autologous split-thickness scalp to repair the flap donor site after combined resection of bilateral expanded ilioinguinal flaps, the donor sites of the other patients were sutured directly. All the flaps survived after operation without tip necrosis or wound residue. Follow-up for 3-30 (15±10) months showed that the flap was soft and not bloated, the function and appearance of the recipient area were significantly improved compared with those before operation, and the appearance of the donor sites was good. At the last follow-up, the patients' satisfaction with the treatment effect of the surgical site scored 4-5 (4.5±0.4). Conclusions The expanded ilioinguinal flap can be obtained in a large area. It has the advantages of rich blood supply, less damage to the donor site, concealed location, and being convenient to be resected and transplanted in combination with the paraumbilical perforator flap. It is suitable for the clinical reconstruction and treatment of severe scar contracture deformity after extensive burns.
- Burns /
- Cicatrix /
- Contracture /
- Dilatation /
- Surgical flaps /
- Free flap /
- Ilioinguinal region
陈斓：手术操作、数据整理以及论文撰写；张伟、谢卫国：手术操作、论文撰写、研究指导、论文修改、经费支持；杨飞：手术操作、论文撰写；李泽：数据整理、统计学分析

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1 左侧扩张髂腹股沟皮瓣设计示意图

下载: 全尺寸图片幻灯片

2 右侧扩张髂腹股沟皮瓣游离移植治疗例1火焰烧伤后患者左手瘢痕挛缩畸形。2A、2B.分别为入院时左手侧面观、背面观，手背瘢痕粘连，第1~5指爪形畸形；2C.右侧髂腹股沟区置入皮肤软组织扩张器注水扩张9个月后；2D.切取右侧扩张髂腹股沟皮瓣修复左手腕部瘢痕切除松解后创面；2E.术后5个月左手畸形明显改善；2F、2G.分别为术后5个月左手功能位、握拳；2H.随访5个月，髂腹股沟供瓣区外观良好

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3 双侧髂腹股沟扩张皮瓣治疗例2火焰烧伤患者右肩、右上臂瘢痕挛缩畸形。3A.双侧髂腹股沟区置入皮肤软组织扩张器注水扩张4个月后，右侧皮肤软组织扩张器外露；3B.切取右侧髂腹股沟皮瓣；3C.右上臂后侧片状瘢痕挛缩，右肘右肩部活动受限；3D.右上臂游离皮瓣术后7个月，右肩部和腋窝后皱襞肥厚瘢痕术前；3E.设计左侧髂腹股沟游离皮瓣；3F.切取左侧髂腹股沟游离皮瓣移植修复右肩部和腋窝后皱襞瘢痕切除松解后创面；3G.随访5个月，右腋窝右肘部活动明显改善；3H.随访5个月，髂腹股沟供瓣区形态外观良好

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