腓浅动脉穿支双叶皮瓣修复手指相邻2处创面的效果

张韬; 程俊楠; 杨林; 孙丰文; 高钦锋; 黄永涛; 杨成鹏; 曹阳; 柳志锦; 巨积辉

doi:10.3760/cma.j.cn501225-20220930-00428

腓浅动脉穿支双叶皮瓣修复手指相邻2处创面的效果

doi: 10.3760/cma.j.cn501225-20220930-00428

苏州瑞华骨科医院手外科，苏州　　215104

基金项目:

苏州市姑苏卫生人才计划项目 2020075

苏州市姑苏卫生人才培养项目 GSWS2020116

苏州市民生科技项目关键技术应用研究 SS202092

苏州市卫生科教临床重点病种诊疗技术专项 LCZX202026

苏州市企业工程技术研究中心专项 SZS2019263

苏州市科教兴卫青年科技项目 KJXW2019073

详细信息

通讯作者:
巨积辉，Email：jjh2006@263.net

计量
- 文章访问数: 222
- HTML全文浏览量: 80
- PDF下载量: 24
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-30

Effects of bilobated superficial peroneal artery perforator flap in repairing two adjacent wounds of the fingers

Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China

Funds:

Suzhou Gusu Health Talents Plan Program 2020075

Suzhou Gusu Health Talent Training Project GSWS2020116

Key Technology Application Research of Suzhou Livelihood Science and Technology Project SS202092

Special Project on Diagnosis and Treatment Technology of Clinical Key Disease Species of Health Science and Education in Suzhou LCZX202026

Special Project of Suzhou Enterprise Engineering Technology Research Center SZS2019263

Suzhou Science and Education Revitalization Health Youth Science and Technology Project KJXW2019073

More Information

Corresponding author: Ju Jihui, Email: jjh2006@263.net

摘要

摘要: 目的探讨腓浅动脉穿支双叶皮瓣修复手指相邻2处创面的疗效。方法采用回顾性观察性研究方法。2021年1月—2022年1月，苏州瑞华骨科医院收治15例符合入选标准的手指存在相邻2处创面患者，其中男10例、女5例，年龄25~51岁。清创后单处创面面积为2.5 cm×2.0 cm~7.5 cm×2.5 cm。创面均采用小腿腓浅动脉穿支双叶皮瓣修复，双叶皮瓣的单叶面积为3.0 cm×2.0 cm~8.0 cm×3.0 cm。将所有供区创面直接缝合。术中记录切取皮瓣数量、携带穿支数量和类型，测量穿支和腓浅动脉口径及血管蒂长度。术后记录皮瓣成活情况及供受区创面愈合情况。随访记录供受区恢复情况。末次随访时，采用综合评价量表评定皮瓣修复效果，采用英国医学研究会感觉功能评定标准评定皮瓣感觉功能。结果术中成功切取15个双叶皮瓣，共携带36条腓浅动脉穿支，均为肌间隔穿支，口径为0.2~0.8 mm；携带腓浅动脉口径为0.4~1.1 mm；血管蒂长度为3~8 cm。术后皮瓣全部成活，未发生血管危象，供受区创面均愈合良好。术后随访6~12个月，患者皮瓣颜色、质地均与手部正常组织接近，其中10例患者皮瓣外观良好；另外5例患者因皮瓣外观较臃肿，于术后6个月行Ⅱ期皮瓣削薄成形术。小腿供区仅遗留线状瘢痕，未见明显瘢痕增生或色素沉着，供区远端肢体感觉及运动功能无明显不良影响。末次随访时，15例患者皮瓣修复效果评定中优者11例、良者4例，皮瓣感觉功能评定均为S ₂级。结论腓浅动脉穿支双叶皮瓣肌间隔穿支比例高，血供充足可靠。采用该皮瓣修复手指相邻2处创面，供区损伤小，仅需吻合1组血管便可修复2处创面，降低显微操作难度，可获得较佳的皮瓣修复效果及感觉功能。
- 穿支皮瓣 /
- 手损伤 /
- 显微外科手术 /
- 创面修复 /
- 双叶皮瓣
Abstract: Objective To investigate the therapeutic efficacy of bilobated superficial peroneal artery perforator flap in repairing two adjacent wounds of the fingers. Methods A retrospective observational study was conducted. From January 2021 to January 2022, 15 patients with two adjacent wounds of the fingers who met the inclusion criteria were hospitalized in Suzhou Ruihua Orthopaedic Hospital, including 10 males and 5 females, aged 25 to 51 years. The area of single wound after debridement was from 2.5 cm×2.0 cm to 7.5 cm×2.5 cm. All the wounds were repaired by the bilobated superficial peroneal artery perforator flap from the lower leg. The single lobe area of bilobated flap was from 3.0 cm×2.0 cm to 8.0 cm×3.0 cm. The wounds in all the donor sites were sutured directly. During the operation, the number of resected flaps, the number and type of carried perforators were recorded, and the calibers of perforator and superficial peroneal artery and the length of vascular pedicle were measured. The survival of flap and the wound healing in the donor and recipient sites were recorded after operation. The recovery of donor and recipient sites were recorded during follow-up. At the last follow-up, the repair effect of flap was evaluated by the comprehensive evaluation scale, and the sensory function of flap was evaluated by the sensory function evaluation standard of British Medical Research Association. Results During the operation, 15 bilobated flaps were successfully resected, carrying 36 superficial peroneal artery perforators, all of which were septocutaneous perforators with the caliber of 0.2-0.8 mm. The caliber of superficial peroneal artery was 0.4-1.1 mm and the length of vascular pedicle was 3-8 cm. After operation, all the flaps survived with no vascular crisis occurred, and the wounds in donor and recipient sites healed well. During the follow-up of 6 to 12 months, the color and texture of flaps were similar to those of normal tissue in the hand and the appearance of flap was good in 10 cases; the other 5 cases underwent the stage Ⅱ flap thinning and plastic surgery 6 months after operation due to the bloated appearance of flaps. There was only linear scar in the donor site of lower leg, with no obvious scar hyperplasia or pigmentation, and there was no obvious adverse effect on the sensation or motor function of the distal limbs in the donor area. At the last follow-up, the repair effect of flap of 15 patients was excellent in 11 cases and good in 4 cases, and the sensory function of the flap was evaluated as grade S ₂ in all cases. Conclusions The bilobated superficial peroneal artery perforator flap has high proportion of septocutaneous perforator, and the blood supply is sufficient and reliable. Using this flap to repair two adjacent wounds of the fingers causes minimal damage to the donor area, only one group of blood vessels is needed to be anastomosed to repair two wounds, the difficulty of microoperation is reduced, and good flap repair effect and sensory function can be obtained.
- Perforator flap /
- Hand injuries /
- Microsurgery /
- Wound repair /
- Bilobated flap
张韬：酝酿和设计研究、实施手术、采集资料、分析数据、撰写论文；程俊楠、杨林：实施手术、采集资料、分析数据；孙丰文、高钦锋、黄永涛、杨成鹏、曹阳：实施手术、采集资料；柳志锦：实施手术、分析数据、修改文章；巨积辉：酝酿和设计研究、实施手术、分析数据、修改文章、获取研究经费

所有作者均声明不存在利益冲突

HTML全文

参考文献(29)

[1]	唐举玉,徐达传,徐永清,等.特殊形式穿支皮瓣及其衍生术式命名专家共识[J].中华显微外科杂志,2022,45(1):5-13.DOI: 10.3760/cma.j.cn441206-20220114-00010.
[2]	熊胜,巨积辉,金光哲,等.游离同侧多块小腿腓浅动脉穿支皮瓣修复手部多发创面效果观察[J].中华烧伤杂志,2019,35(9):655-660.DOI: 10.3760/cma.j.issn.1009-2587.2019.09.003.
[3]	张韬,杨林,程俊楠,等. “ABC”三线定位穿支方法在游离小腿前外侧穿支皮瓣的应用[J]. 中华显微外科杂志,2023,46(1):70-75. DOI: 10.3760/cma.j.cn441206-20220530-00107.
[4]	肖飞鹏,柳志锦,刘胜哲,等.综合评价量表在股前外侧皮瓣修复术后疗效评价中的应用[J].中国美容整形外科杂志,2021,32(6):348-351.DOI: 10.3969/j.issn.1673-7040.2021.06.010.
[5]	NikiH,AokiH,InokuchiS,et al.Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders I: development of standard rating system[J].J Orthop Sci,2005,10(5):457-465.DOI: 10.1007/s00776-005-0936-2.
[6]	JiaoXG, CuiCX, NgSK, et al. The modified bilobed flap for reconstructing sacral decubitus ulcers[J/OL]. Burns Trauma,2020,8:tkaa012[2022-09-30]. https://pubmed.ncbi.nlm.nih.gov/33335930/. DOI: 10.1093/burnst/tkaa012.
[7]	张伟,谢卫国,杨飞,等.游离股前外侧穿支皮瓣分叶移植在四肢电烧伤治疗中的临床应用[J].中华烧伤杂志,2019,35(11):790-797.DOI: 10.3760/cma.j.issn.1009-2587.2019.11.005.
[8]	杨力,蔡斌,薛君荣,等.个体化股前外侧皮瓣游离移植修复复杂难愈性创面的临床效果[J].中华烧伤杂志,2020,36(8):730-734.DOI: 10.3760/cma.j.cn501120-20190621-00281.
[9]	冯宇杰,朱江,吴森斌,等.游离腓动脉双叶穿支皮瓣修复颌面部恶性肿瘤术后缺损[J].中华整形外科杂志,2022,38(11):1254-1257.DOI: 10.3760/cma.j.cn114453-20211231-00492.
[10]	许操,李建成,宋培军,等.腓动脉穿支双叶皮瓣在舌癌、口底癌术后缺损修复中的应用[J].中华整形外科杂志,2020,36(8):893-898.DOI: 10.3760/cma.j.cn114453-20191224-00383.
[11]	李建成,宋培军,杨东昆,等.小腿后外侧腓动脉双叶穿支游离皮瓣修复口腔颌面部恶性肿瘤术后面部洞穿性缺损[J].中华显微外科杂志,2019,42(1):26-31.DOI: 10.3760/cma.j.issn.1001-2036.2019.01.008.
[12]	LucattelliE,BrogiM,CiprianiF,et al.Oromandibular reconstruction with double-skin paddle fibular free flap: a systematic review and meta-analysis[J].Microsurgery,2021,41(7):676-687.DOI: 10.1002/micr.30786.
[13]	ChangEI,YuPR.Prospective series of reconstruction of complex composite mandibulectomy defects with double island free fibula flap[J].J Surg Oncol,2017,116(2):258-262.DOI: 10.1002/jso.24647.
[14]	LiKW,LiuJ,LiuMJ,et al.Free multilobed posterior interosseous artery perforator flap for multi-finger skin defect reconstruction[J].J Plast Reconstr Aesthet Surg,2015,68(1):9-16.DOI: 10.1016/j.bjps.2014.08.063.
[15]	SaenthaveesukP,ZhangSE,ZhengGS,et al.Use of medial upper arm free flap in oral cavity reconstruction: a preliminary study[J].Int J Oral Maxillofac Surg,2018,47(5):595-602.DOI: 10.1016/j.ijom.2017.12.008.
[16]	刘胜哲,巨积辉,柳志锦,等.串并联双侧股前外侧超长穿支皮瓣修复四肢大面积创面的临床效果[J].中华烧伤杂志,2021,37(3):250-256.DOI: 10.3760/cma.j.cn501120-20200226-00096.
[17]	周荣,巨积辉,唐林峰,等.带感觉神经的股前外侧穿支皮瓣修复足底皮肤软组织缺损的临床效果[J].中华烧伤杂志,2021,37(5):453-459.DOI: 10.3760/cma.j.cn501120-20200309-00136.
[18]	巨积辉,周荣,刘跃飞,等.超长股外侧区内增压型穿支皮瓣修复足踝部创面的临床效果[J].中华烧伤杂志,2019,35(7):495-500.DOI: 10.3760/cma.j.issn.1009-2587.2019.07.004.
[19]	夏成德,狄海萍,邢培朋,等.游离股前外侧皮瓣修复烧伤后小腿环形大面积软组织缺损的临床效果[J].中华烧伤杂志,2019,35(4):248-252.DOI: 10.3760/cma.j.issn.1009-2587.2019.04.003.
[20]	XueBJ,LiuYB,ZhuS,et al.Total cheek reconstruction using the pre-expanded medial arm flap with functional and aesthetic donor site closure[J].J Craniofac Surg,2018,29(3):640-644.DOI: 10.1097/SCS.0000000000004127.
[21]	张韬,杨林,程俊楠,等. 游离腓浅动脉穿支皮瓣修复手部热压伤创面的疗效分析研究[J]. 中华手外科杂志,2023,39(2):132-135. DOI: 10.3760/cma.j.cn311653-20220902-00229.
[22]	程贺云,张韬,巨积辉,等.Flow-through腓浅动脉皮瓣修复手指伴指掌侧固有动脉缺损创面[J].中华显微外科杂志,2021,44(4):369-373.DOI: 10.3760/cma.j.cn441206-20210111-00011.
[23]	石岩,何晓清,杨曦,等.CT血管造影检查结合三维重建辅助设计腓浅动脉穿支皮瓣修复手部创面的疗效[J].中华创伤杂志,2021,37(6):501-507.DOI: 10.3760/cma.j.cn501098-20210202-00105.
[24]	熊胜,巨积辉,金光哲,等.彩超定位下游离腓浅动脉穿支皮瓣修复手足部创面[J].中华手外科杂志,2018,34(6):418-420.DOI: 10.3760/cma.j.issn.1005-054X.2018.06.007.
[25]	秦向征,刘鹏,许东元,等.腓浅动脉皮支链的应用解剖[J].中华显微外科杂志,2015,38(1):66-69.DOI: 10.3760/cma.j.issn.1001-2036.2015.01.016.
[26]	YangXD,ZhangGF,LiuYW,et al.Vascular anatomy and clinical application of anterolateral leg perforator flaps[J].Plast Reconstr Surg,2013,131(4):534e-543e.DOI: 10.1097/PRS.0b013e3182827675.
[27]	StoccoC,MurphyDC,GargiuloM,et al.Superficial peroneal nerve accessory artery (SPNAA) flap for head and neck reconstruction: a cadaveric anatomical study and retrospective case series review[J].J Plast Reconstr Aesthet Surg,2021,74(7):1524-1533.DOI: 10.1016/j.bjps.2020.11.012.
[28]	PanagiotopoulosK,SoucacosPN,KorresDS,et al.Anatomical study and colour Doppler assessment of the skin perforators of the anterior tibial artery and possible clinical applications[J].J Plast Reconstr Aesthet Surg,2009,62(11):1524-1529.DOI: 10.1016/j.bjps.2008.06.013.
[29]	ZeidermanMR,PuLLQ.Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma[J/OL].Burns Trauma,2021,9:tkab024[2022-09-30].https://pubmed.ncbi.nlm.nih.gov/34345630/.DOI: 10.1093/burnst/tkab024.

下载: 全尺寸图片幻灯片

1 腓浅动脉穿支双叶皮瓣修复例1患者左手中指掌侧和背侧相邻2处创面。1A、1B.分别为急诊清创后，左手中指中末节掌侧和背侧皮肤缺损、肌腱外露，左手示、环指掌侧和背侧表皮缺损、无肌腱外露；1C.以腓骨小头与外踝尖连线向胫骨侧平移1.5 cm的线为皮瓣轴心线（中间的直线），以该线中点近、远端2.0 cm为血管蒂设计皮瓣；1D.皮瓣分叶后，断蒂前；1E.供区创面直接缝合后即刻；1F、1G.分别为皮瓣修复术后11个月随访左手背侧、掌侧，皮瓣存活良好，外观不臃肿；1H.皮瓣修复术后11个月随访，右小腿供区仅遗留线状瘢痕

下载: 全尺寸图片幻灯片

2 腓浅动脉穿支双叶皮瓣修复例2患者左手中、环指掌侧相邻2处创面。2A.皮瓣修复术前，左手中指中节、环指近节尺掌侧皮肤坏死，界限清晰；2B.以轴心线（B线）中点近、远端2.0 cm为血管蒂设计皮瓣；2C.皮瓣分叶后，断蒂前；2D.皮瓣切取后转移至创面前；2E.皮瓣修复术后即刻，皮瓣颜色与手部接近，外观不臃肿；2F.右小腿供区创面直接缝合后即刻；2G.皮瓣修复术后6个月随访，皮瓣存活良好，外观不臃肿；2H.皮瓣修复术后6个月随访，右小腿供区仅遗留线状瘢痕

下载: 全尺寸图片幻灯片