携带骨膜的低位外踝上皮瓣与小腿近端螺旋桨皮瓣接力修复前足电烧伤创面的效果

孟艳斌; 张海瑞; 魏建伟; 张毓姣; 李虎山; 霍文亮; 白培懿

doi:10.3760/cma.j.cn501225-20230421-00138

携带骨膜的低位外踝上皮瓣与小腿近端螺旋桨皮瓣接力修复前足电烧伤创面的效果

doi: 10.3760/cma.j.cn501225-20230421-00138

1.
太钢总医院（山西医科大学第六医院）烧伤科，太原　　030009
2.
中南大学湘雅二医院骨科，长沙　　410011

基金项目:

湖南省自然科学基金面上项目 2022JJ30852

详细信息

通讯作者:
孟艳斌，Email：m64225@163.com

计量
- 文章访问数: 1765
- HTML全文浏览量: 48
- PDF下载量: 15
- 被引次数: 0
出版历程
- 收稿日期: 2023-04-21

Effects of low position lateral supramalleolar flap carrying periosteum and proximal leg propeller flap in relay repair of electric burn wounds of forefoot

1.
Institute of Burns, General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University), Taiyuan 030009, China
2.
Department of Orthopedics, the Second Xiangya Hospital of Central South University, Changsha 410011, China

Funds:

General Program of Natural Science Foundation of Hunan Province of China 2022JJ30852

More Information

Corresponding author: Meng Yanbin, Email: m64225@163.com

摘要

摘要: 目的探讨携带骨膜的低位外踝上皮瓣与小腿近端螺旋桨皮瓣接力修复前足电烧伤创面的效果。方法采用回顾性观察性研究方法。2019年1月—2022年1月，山西医科大学第六医院收治12例符合入选标准的前足电烧伤患者，其中男10例、女2例，年龄23~65岁。清创后创面面积为6.0 cm×3.0 cm~15.0 cm×7.0 cm，以携带胫骨、腓骨远端部分骨膜且旋转点下移至踝关节前方的外踝上皮瓣修复创面，皮瓣切取面积为6.5 cm×3.5 cm~15.5 cm×7.5 cm，同期以腓动脉或腓浅动脉穿支螺旋桨皮瓣接力修复外踝上皮瓣供区创面，接力皮瓣面积为3.0 cm×1.5 cm~15.0 cm×4.0 cm。术后，观察外踝上皮瓣及接力皮瓣成活情况、接力皮瓣供区创面愈合情况。随访时，观察移植后的外踝上皮瓣及其供区外形。结果术后，1例患者外踝上皮瓣远端皮肤浅层继发水疱，经换药后愈合，其余患者外踝上皮瓣及接力皮瓣均完全成活；接力皮瓣供区创面愈合良好。随访12~18个月，外踝上皮瓣外形佳且不臃肿，该皮瓣供区仅遗留线性瘢痕。结论以携带骨膜的低位外踝上皮瓣修复前足电烧伤创面，具有血运可靠、旋转点低、修复效果较佳等优点。利用接力皮瓣修复外踝上皮瓣供区，减轻了对供区外观和功能的损害。
- 烧伤，电 /
- 足前段，人 /
- 接力皮瓣 /
- 低位外踝上皮瓣 /
- 创面修复
Abstract: Objective To explore the effects of low position lateral supramalleolar flap carrying periosteum and proximal leg propeller flap in relay repair of electric burn wounds of forefoot. Methods A retrospective observational study was conducted. From January 2019 to January 2022, 12 patients with electric burn wounds of forefoot meeting the inclusion criteria were admitted to the Sixth Hospital of Shanxi Medical University, including 10 males and 2 females, aged 23-65 years. After debridement, the wound with an area of 6.0 cm×3.0 cm to 15.0 cm×7.0 cm was repaired with the lateral supramalleolar flap carrying part of the periosteum of the distal tibia and fibula with the rotation point moved down to the front of the ankle joint. The area of the cutted flap was 6.5 cm×3.5 cm-15.5 cm×7.5 cm. At the same stage, the donor site wound of lateral supramalleolar flap was repaired with peroneal artery or superficial peroneal artery perforator propeller flap in relay, with the relay flap area of 3.0 cm×1.5 cm-15.0 cm×4.0 cm. After operation, the survival of the lateral supramalleolar flap and relay flap, and the wound healing of the relay flap donor site were observed. During follow-up, the shapes of the lateral supramalleolar flap and its donor site were observed. Results After operation, one patient developed secondary blisters in the superficial skin distal to the lateral supramalleolar flap, which healed after dressing change, and the lateral supramalleolar flap and relay flaps survived well in the other patients; the donor site wound of the relay flap healed well. During follow-up of 12-18 months, the lateral supramalleolar flaps were in good shape and not bloated, with only linear scar left in the donor site of the flap. Conclusions The low position lateral supramalleolar flap carrying periosteum can repair electric burn wounds of forefoot with advantages including reliable blood supply, low rotation point, and better repair effects. The use of relay flap to repair the donor site of lateral supramalleolar flap can reduce the damage to the appearance and function of the donor site.
- Burns, electric /
- Forefoot, human /
- Relay flap /
- Low position lateral supramalleolar flap /
- Wound repair
孟艳斌：酝酿和设计研究、实施手术、撰写及修改论文；张海瑞、张毓姣、李虎山：实施手术、收集资料、分析数据；魏建伟：整理及分析数据、经费支持；霍文亮、白培懿：收集资料

所有作者均声明不存在利益冲突

HTML全文

参考文献(26)

[1]	沈余明, 胡骁骅, 覃凤均, 等. 足背严重软组织缺损的皮瓣修复[J].中华烧伤杂志,2014,30(2):141-143. DOI: 10.3760/cma.j.issn.1009-2587.2014.02.010.
[2]	MasqueletAC, RomanaMC, WolfG. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg[J]. Plast Reconstr Surg, 1992,89(6):1115-1121. DOI: 10.1097/00006534-199206000-00018.
[3]	宋科, 周明武, 熊颖杰, 等. 旋转点下移的外踝上穿支皮瓣在修复前足软组织缺损的临床应用[J].中华显微外科杂志,2019,42(1):17-20. DOI: 10.3760/cma.j.issn.1001-2036.2019.01.006.
[4]	黄伟雄, 王明月, 季鹏, 等. 改良外踝上皮瓣修复前足背皮肤软组织缺损[J].中华显微外科杂志,2015,38(4):401-403. DOI: 10.3760/cma.j.issn.1001-2036.2015.04.029.
[5]	陈黎明, 王刚, 刘毅. 低位旋转点的外踝上穿支岛状皮瓣修复足部皮肤软组织缺损创面的临床效果[J].中华烧伤与创面修复杂志,2022,38(10):932-936. DOI: 10.3760/cma.j.cn501120-20210630-00231.
[6]	张世民, 顾玉东, 徐达传, 等. 踝部血管网对小腿远端蒂皮瓣的供血作用[J].中国临床解剖学杂志,2002,20(3):201-203. DOI: 10.3969/j.issn.1001-165X.2002.03.013.
[7]	路来金, 彭维海, 张舵, 等. 逆行外踝上筋膜皮瓣修复前足缺损的解剖学基础[J].中华显微外科杂志,2004,27(3):200-202. DOI: 10.3760/cma.j.issn.1001-2036.2004.03.014.
[8]	陈雪松, 徐永清, 陈建明, 等. 外踝上穿支蒂腓浅神经营养血管皮肤筋膜瓣修复足背皮瓣供区[J].中华整形外科杂志,2013,29(5):345-348. DOI: 10.3760/cma.j.issn.1009-4598.2013.05.007.
[9]	宋守礼,朱盛修. 骨膜的组织学特征和超微结构[J]. 中华骨科杂志,1996(6):60-62.
[10]	ZengJJ, GuoP, ZhouN, et al. Treatment of large bone defects with a novel biological transport disc in non-vascular transport distraction osteogenesis[J]. Int J Oral Maxillofac Surg, 2016,45(5):670-677. DOI: 10.1016/j.ijom.2015.12.012.
[11]	张大卫, 黄东, 牟勇, 等. 游离骨膜瓣联合自体骨治疗胫骨下段粉碎性骨折及骨不连[J].中华显微外科杂志,2015,38(1):88-90. DOI: 10.3760/cma.j.issn.1001-2036.2015.01.025.
[12]	MarupanthornK, TantrawatpanC, KheolamaiP, et al. Bone morphogenetic protein-2 enhances the osteogenic differentiation capacity of mesenchymal stromal cells derived from human bone marrow and umbilical cord[J]. Int J Mol Med, 2017,39(3):654-662. DOI: 10.3892/ijmm.2017.2872.
[13]	张宏宁, 朱永展, 沈国栋, 等. 不带腓浅神经的外踝上穿支降支蒂螺旋桨皮瓣在中前足创面修复中的应用[J].中华显微外科杂志,2017,40(6):588-590. DOI: 10.3760/cma.j.issn.1001-2036.2017.06.022.
[14]	ZeidermanMR, PuLLQ. Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma[J/OL]. Burns Trauma,2021,9:tkab024[2023-04-21].https://pubmed.ncbi.nlm.nih.gov/34345630/.DOI: 10.1093/burnst/tkab024.
[15]	刘军, 余国荣, 陶圣祥, 等. 腓浅神经营养血管筋膜皮瓣的应用解剖[J].武汉大学学报(医学版),2007,28(1):107-108,116. DOI: 10.3969/j.issn.1671-8852.2007.01.028.
[16]	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.
[17]	柴益民, 林崇正, 邱勋永, 等. 带皮穿支血管的皮神经营养血管皮瓣的临床应用[J].中华整形外科杂志,2006,22(1):34-37. DOI: 10.3760/j.issn:1009-4598.2006.01.009.
[18]	KhoongYM, HuangX, GuS, et al. Imaging for thinned perforator flap harvest: current status and future perspectives[J/OL]. Burns Trauma,2021,9:tkab042[2023-04-21].https://pubmed.ncbi.nlm.nih.gov/34926708/.DOI: 10.1093/burnst/tkab042.
[19]	AokiS, TanumaK, IwakiriI, et al. Clinical and vascular anatomical study of distally based sural flap[J]. Ann Plast Surg, 2008,61(1):73-78. DOI: 10.1097/SAP.0b013e318153f3da.
[20]	李涛, 陈振兵, 丛晓斌, 等. 保留腓肠神经的小腿后外侧穿支皮瓣的临床应用[J].中华手外科杂志,2016,32(2):127-129. DOI: 10.3760/cma.j.issn.1005-054X.2016.02.025.
[21]	唐举玉, 汪华侨, HallockGG, 等. 关注皮瓣供区问题—减少皮瓣供区损害专家共识[J].中华显微外科杂志,2018,41(1):3-5. DOI: 10.3760/cma.j.issn.1001-2036.2018.01.001.
[22]	侯春林,顾玉东.皮瓣外科学[M].2版.上海:上海科学技术出版社,2013:636-638.
[23]	HyakusokuH, YamamotoT, FumiiriM. The propeller flap method[J]. Br J Plast Surg, 1991,44(1):53-54. DOI: 10.1016/0007-1226(91)90179-n.
[24]	HallockGG. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores[J]. Ann Plast Surg, 2006,56(5):540-542. DOI: 10.1097/01.sap.0000210512.81988.2b.
[25]	PignattiM, OgawaR, HallockGG, et al. The "Tokyo" consensus on propeller flaps[J]. Plast Reconstr Surg, 2011,127(2):716-722. DOI: 10.1097/PRS.0b013e3181fed6b2.
[26]	何晓清, 范新宇, 徐永清. 腓动脉和胫后动脉穿支螺旋桨皮瓣的应用[J].中华显微外科杂志,2022,45(6):705-709. DOI: 10.3760/cma.j.cn441206-20220913-00190.

下载: 全尺寸图片幻灯片

1 携带骨膜的低位外踝上皮瓣与小腿近端螺旋桨皮瓣接力修复患者右前足电烧伤创面的效果。1A.入院时右足电烧伤创面情况，可见创面处有大量黑色焦痂；1B.清创后，第5跖骨外露，跖趾关节开放，设计低位外踝上皮瓣；1C.切取外踝上皮瓣术中，探查外踝上穿支；1D、1E.分别为外踝上皮瓣分离术中及分离完成后即刻；1F.分离接力皮瓣术中；1G.接力皮瓣覆盖创面并缝合后即刻；1H.术后12个月随访时，外踝上皮瓣供区仅遗留线性瘢痕

下载: 全尺寸图片幻灯片