微型游离腹股沟穿支皮瓣修复手部小型创面的效果

刘峰; 张伟; 谢卫国; 陈斓; 张卫东; 周锦秀; 李泽

doi:10.3760/cma.j.cn501225-20230701-00244

微型游离腹股沟穿支皮瓣修复手部小型创面的效果

doi: 10.3760/cma.j.cn501225-20230701-00244

武汉大学同仁医院暨武汉市第三医院烧伤科，武汉　　430060

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张伟，Email：zhw010@163.com

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- 收稿日期: 2023-07-01

Effects of miniature free groin perforator flaps in repairing small wounds on hands

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

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

摘要

摘要: 目的探讨微型游离腹股沟穿支皮瓣修复手部小型创面的效果。方法采用回顾性观察性研究方法。2020年7月—2022年10月，武汉大学同仁医院暨武汉市第三医院收治15例手部小型创面患者（共16处创面），其中男12例、女3例，年龄19~56岁。清创后皮肤软组织缺损范围为2.0 cm×1.5 cm~6.0 cm×3.0 cm。根据创面缺损范围和形状于腹股沟区设计13个单叶穿支皮瓣和2个双叶穿支皮瓣，皮瓣大小为4.5 cm×2.5 cm~7.5 cm×3.5 cm。根据受区情况，将皮瓣蒂部动静脉分别与受区动静脉吻合。对供瓣区创面进行分层减张缝合封闭。术中测量皮瓣厚度。术后观察皮瓣存活情况，记录供受区并发症发生情况；随访观察皮瓣外观、质地；末次随访时，评估患手感觉恢复情况，采用中华医学会手外科学会上肢部分功能评定试用标准评估患手功能，观察供受区瘢痕情况并询问患者对疗效的满意度。结果皮瓣厚度为0.3~1.0 cm，平均0.6 cm。术后，11个单叶皮瓣和2个双叶皮瓣存活良好，其余2个单叶皮瓣中的1个皮瓣术后出现静脉危象，予以拆线减张、皮瓣放血等处理后逐渐恢复正常，1个皮瓣尖端少许坏死，经换药处理后愈合；供受区均无并发症发生。术后随访8~35个月，皮瓣弹性好，质地软；8个皮瓣稍臃肿，于术后3~8个月行皮瓣修整术，其余皮瓣外观较佳。末次随访时，所有皮瓣均恢复保护性感觉；患手功能评定为优者10例、良者4例、可者1例，供受区仅遗留线状瘢痕，患者对患手外观和功能恢复表示满意。结论微型游离腹股沟穿支皮瓣修复手部小型创面，具有皮瓣成活率高、供瓣区隐蔽、损伤小、并发症少、修复效果较好等优点，具有临床应用价值，推荐用于修复手部非功能区创面。
- 手 /
- 外科手术 /
- 腹股沟 /
- 游离皮瓣 /
- 微型皮瓣 /
- 创面修复
Abstract: Objective To investigate the effects of miniature free groin perforator flaps in repairing small wounds on hands. Methods The retrospective observational study was conducted. Fifteen patients with 16 small wounds on hands were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital from July 2020 to October 2022, including 12 males and 3 females, aged 19 to 56 years. The size of skin and soft tissue defect was 2.0 cm×1.5 cm to 6.0 cm×3.0 cm after debridement. According to size and shape of the wounds, 13 single-lobe perforator flaps and 2 bilobed perforator flaps were designed in the groin region, with the flap size of 4.5 cm×2.5 cm to 7.5 cm×3.5 cm. According to the condition of the recipient area, the arteries and veins at the pedicle of the flap were anastomosed to the arteries and veins of the recipient area respectively. The wounds in the donor area of the flap was closed by layered and tension-reducing suture. The thickness of the flap was measured during operation. The survival of the flap was observed, and the complications in the donor and recipient areas were recorded after operation. The appearance and texture of the flap were observed during follow-up. At the last follow-up, the sensory recovery of the affected hand was evaluated, the function of the affected hand was evaluated according to the trial standard of the upper limb partial function evaluation of the Hand Surgery Society of the Chinese Medical Association, the scar in the donor and recipient areas were observed, and the satisfaction of patients for the curative effects was inquired. Results The thickness of the flap was ranged from 0.3 to 1.0 cm, with an average thickness of 0.6 cm. After operation, 11 single-lobe flaps and 2 bilobed flaps survived well; in the left 2 single-lobe flaps, one flap had venous crisis but returned to normal after removing stitches to reduce tension and bloodletting of flaps, while the other one flap had a little necrosis on tip but healed after dressing change. No complications occurred in donor and recipient areas. During follow-up of 8 to 35 months after operation, the flaps had good elasticity and soft texture; 8 flaps were slightly bloated and were trimmed 3 to 8 months after operation, while the appearances of the other flaps were good. At the last follow-up, all flaps recovered protective feeling; the function of the affected hand was evaluated as excellent in 10 cases, good in 4 cases, and fair in 1 case; only linear scar remained in the donor and recipient areas; the patients were satisfied with the appearance and function recovery of the affected hand. Conclusions The miniature free groin perforator flaps in repairing small wounds on hands have the advantages of high survival rate of flaps, hidden flap donor area, little damage, few complications, good repair effect, etc., showing clinical application value. It is recommended for repairing non-functional wounds on hands.
- Hand /
- Surgical procedures, operative /
- Groin /
- Free flaps /
- Miniature flaps /
- Wound repair
刘峰：酝酿和设计研究、实施手术、采集资料、分析数据、撰写论文；张伟、谢卫国：酝酿和设计研究、实施手术、指导论文书写、修改论文；陈斓、张卫东、周锦秀、李泽：实施手术、采集资料

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1 游离腹股沟穿支皮瓣修复例1患者右手拇指电烧伤创面的效果。1A.入院时创面皮肤软组织坏死呈焦黄色，创周轻度红肿，指端血运正常；1B.适当扩大清创后，创面部分肌腱坏死外露；1C.于左侧腹股沟区设计面积为7.0 cm×3.0 cm的皮瓣；1D.皮瓣断蒂前行吲哚菁绿荧光造影，血管蒂部显示明显，皮瓣动脉血流灌注和静脉回流较好（左侧小图从上到下分别为高清白光图、标准荧光图、彩色荧光图，右侧大图为高清白光图）；1E.皮瓣断蒂后，厚度约0.4 cm；1F.术后即刻，皮瓣与创面形状大小匹配良好；1G.血管吻合后再次行吲哚菁绿荧光造影，皮瓣动脉血流灌注和静脉回流较好（左侧小图从上到下分别为高清白光图、标准荧光图、彩色荧光图，右侧大图为高清白光图）;1H.术后12个月随访时皮瓣成活，外形略臃肿

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2 游离腹股沟穿支皮瓣修复例2患者右手示指氢氟酸腐蚀伤创面的效果。2A.入院时右手示指末节指甲和甲床缺如，骨外露且发黑坏死；2B.根据创面大小和形状设计面积6.0 cm×2.2 cm的左侧腹股沟皮瓣；2C.根据创面形状和穿支分布对皮瓣进行分叶处理；2D.将分叶皮瓣去脂削薄后移植于创面后即刻效果；2E、2F.分别为术后14个月随访时示指屈曲和伸直时，皮瓣些许臃肿，示指关节活动度好

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