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

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

黄宇¹,
黄波^1, ,,
刘安铭¹,
唐林¹,
周鑫²,
王韶亮²,
邹永根³

1.
西南医科大学附属中医医院手外科，泸州　　646000
2.
陆军军医大学（第三军医大学）第二附属医院整形美容外科，重庆　　400037
3.
贵州省人民医院骨科，贵阳　　550000

详细信息

通讯作者:
黄波，Email：Huangbo19860622@163.com

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出版历程
- 收稿日期: 2022-08-31

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

1.
Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
2.
Department of Plastic and Cosmetic Surgery, the Second Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400037, China
3.
Department of Orthopedics, the People's Hospital of Guizhou Province, Guiyang 550000, China

More Information

Corresponding author: Huang Bo, Email: Huangbo19860622@163.com

摘要

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。
- 创伤和损伤 /
- 肿瘤 /
- 显微外科手术 /
- 联体皮瓣 /
- 双蒂腹壁下动脉穿支皮瓣 /
- 软组织缺损 /
- 下肢重建
Abstract: Objective To investigate the curative effects of bi-pedicled deep inferior epigastric perforator (DIEP) flap in repairing large soft tissue defects in the lower limbs. Methods A retrospective observational study was conducted. From February 2016 to June 2020, 16 patients with large soft tissue defects in the lower limbs caused by trauma or after tumor/scar resection were admitted to the Department of Hand Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, including 9 males and 7 females, aged 25-58 years, with the area of soft tissue defects ranging from 14.0 cm×8.0 cm to 32.0 cm×18.0 cm. Using the abdomen as the donor site, the conjoined abdominal wall flap, i.e., the bi-pedicled DIEP flap (with an area ranging from 15.0 cm×9.0 cm to 32.0 cm×20.0 cm) carrying two sets of the trunk of the deep inferior epigastric artery was designed and resected to repair the wound. The donor site wound was sutured directly. The flap survival and wound healing in the donor and recipient areas were observed after operation. The curative effect was evaluated during the follow-up. At the last follow-up, the American Knee Society score and lower extremity functional scale were used to assess the functions of knee joint and lower limb, respectively. Results The flaps of 15 patients survived after operation; the flap of one patient had partial infection at the edge after operation but healed after debridement and dressing change. The wounds in the donor and recipient areas of 16 patients all healed well. Follow-up of 16-28 months showed that the recipient area had a good shape and pliable texture, and there was no obvious swollen appearance, hyperpigmentation, or abnormal hair growth; the donor site had linear scar only, with no complications such as abdominal hernia or hyperplastic scar; the functions of knee joint and lower limb were well reconstructed, with no recurrence of tumor. At the last follow-up, among the 4 patients with knee joint injury, 3 cases were excellent and 1 case was good in the evaluation of knee joint function; among the 12 patients with lower limb injury, 9 cases were excellent and 3 cases were good in the evaluation of lower limb function. Conclusions The donor site of bi-pedicled DIEP flap is concealed with abundant tissue and large area for resection, with which can be used to repair large soft tissue defects in the lower limbs, achieving good short-term results of appearance and function restoration.
- Wounds and injuries /
- Neoplasms /
- Microsurgery /
- Conjoined flap /
- Bi-pedicled deep inferior epigastric perforator flap /
- Soft tissue defect /
- Lower limb reconstruction
黄宇：起草文章；黄波：对文章的知识性内容作批评性审阅；刘安铭、周鑫、王韶亮：负责实施手术；唐林、邹永根：负责数据收集和整理

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参考文献(21)

[1]	MinK,HongJP,SuhHP.Risk factors for partial flap loss in a free flap: a 12-year retrospective study of anterolateral thigh free flaps in 303 lower extremity cases[J].Plast Reconstr Surg,2022,150(5):1071e-1081e.DOI: 10.1097/PRS.0000000000009646.
[2]	HallockGG.Musculoseptocutaneous perforator of anterolateral thigh flap: a clinical study[J].Plast Reconstr Surg,2022,149(1):148e-149e.DOI: 10.1097/PRS.0000000000008642.
[3]	曹学新,陈一衡,赵连民,等.接力穿支皮瓣在股前外侧皮瓣供区修复中的应用[J].中华整形外科杂志,2022,38(10):1111-1118.DOI: 10.3760/cma.j.cn114453-20210507-00206.
[4]	刘晓春,赵鹏,孙大炜,等.股前外侧皮瓣供区并发症分析及预防策略[J].中华显微外科杂志,2022,45(6):680-683.DOI: 10.3760/cma.j.cn441206-20220601-00109.
[5]	Fernández GarridoM,PereiraN,López FernándezS,et al.Turbocharged bilateral pedicled DIEP flap for reconstruction of thigh defect without recipient vessels: a case report[J].Microsurgery,2018,38(3):324-327.DOI: 10.1002/micr.30280.
[6]	HartrampfCR,ScheflanM,BlackPW.Breast reconstruction with a transverse abdominal island flap[J].Plast Reconstr Surg,1982,69(2):216-225.DOI: 10.1097/00006534-198202000-00006.
[7]	HallockGG.Branch-based conjoined perforator flaps[J].Plast Reconstr Surg,2008,121(5):1642-1649.DOI: 10.1097/PRS.0b013e31816aa022.
[8]	BeugelsJ,VasileJV,TuinderSMH,et al.The stacked hemiabdominal extended perforator flap for autologous breast reconstruction[J].Plast Reconstr Surg,2018,142(6):1424-1434.DOI: 10.1097/PRS.0000000000005058.
[9]	MahajanAL,Van WaesC,D'ArpaS,et al.Bipedicled DIEAP flaps for reconstruction of limb soft tissue defects in male patients[J].J Plast Reconstr Aesthet Surg,2016,69(7):920-927.DOI: 10.1016/j.bjps.2016.03.015.
[10]	InsallJN,DorrLD,ScottRD,et al.Rationale of the Knee Society clinical rating system[J].Clin Orthop Relat Res,1989(248):13-14.
[11]	BinkleyJM,StratfordPW,LottSA,et al.The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network[J].Phys Ther,1999,79(4):371-383.
[12]	刘春军,栾杰.腹部皮瓣:乳腺癌术后乳房再造的金标准[J].中华整形外科杂志,2021,37(7):709-711.DOI: 10.3760/cma.j.cn114453-20210708-00291.
[13]	OuQ,WuP,ZhouZ,et al.Algorithm for covering circumferential wound on limbs with ALTP or/and DIEP flaps based on chain-linked design and combined transplantation[J].Injury,2021,52(6):1356-1362.DOI: 10.1016/j.injury.2020.10.031.
[14]	谢庆平,穆籣,刘元波,等.腹壁下动脉穿支皮瓣专家共识[J].中华显微外科杂志,2020,43(5):417-423.DOI: 10.3760/cma.j.cn441206-20200826-00331.
[15]	宋达疆,李赞,章一新,等.联体双侧血管蒂腹壁下动脉穿支皮瓣行乳房重建[J].中华显微外科杂志,2020,43(5):441-445.DOI: 10.3760/cma.j.cn441206-20200225-00097.
[16]	宋达疆,李赞,章一新,等.移植内增压式双侧血管蒂腹壁下动脉穿支皮瓣行乳房再造的临床效果[J].中华烧伤杂志,2021,37(12):1143-1148.DOI: 10.3760/cma.j.cn501120-20200824-00390.
[17]	周鑫,邹永根,唐林,等.携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损[J].中国修复重建外科杂志,2021,35(11):1467-1471.DOI: 10.7507/1002-1892.202106040.
[18]	TangL,ZhouX,ZouY.Coverage of exposed ankle and foot with the conjoined lower abdomen and groin flaps[J].Injury,2022,53(8):2893-2897.DOI: 10.1016/j.injury.2022.06.003.
[19]	张世民.皮瓣远侧血液循环增强技术:外增压、内增压和超回流[J].中华显微外科杂志,2016,39(6):524-525.DOI: 10.3760/cma.j.issn.1001-2036.2016.06.002.
[20]	TongX,LuJ,ZhangW,et al.Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects: a systematic review and meta-analysis of outcomes and complication rates[J/OL].Burns Trauma,2022,10:tkac045[2022-12-30].https://pubmed.ncbi.nlm.nih.gov/36518877/.DOI: 10.1093/burnst/tkac045.
[21]	ZeidermanMR,PuLLQ.Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma[J/OL].Burns Trauma,2021,9:tkab024[2022-08-31].https://pubmed.ncbi.nlm.nih.gov/34345630/.DOI: 10.1093/burnst/tkab024.

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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

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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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