游离旋髂浅动脉浅支穿支皮瓣联合皮瓣供区以远全厚皮片修复四肢较大创面的临床效果

刘洋洋; 吴敏; 朱军; 张宽宽; 牛海州; 高许斌; 韩仲兵; 刘奋斗

doi:10.3760/cma.j.cn501225-20230727-00018

游离旋髂浅动脉浅支穿支皮瓣联合皮瓣供区以远全厚皮片修复四肢较大创面的临床效果

doi: 10.3760/cma.j.cn501225-20230727-00018

蚌埠医学院第一附属医院手足显微外科，蚌埠　　233004

基金项目:

蚌埠医学院自然科学重点项目 2020byzd175

详细信息

通讯作者:
吴敏，Email：wumin200207@163.com

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出版历程
- 收稿日期: 2023-07-27

Clinical effects of free superficial circumflex iliac artery superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities

Department of Hand and Foot Microsurgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China

Funds:

Natural Science Key Project of Bengbu Medical College 2020byzd175

More Information

Corresponding author: Wu Min, Email: wumin200207@163.com

摘要

摘要: 目的探讨游离旋髂浅动脉（SCIA）浅支穿支皮瓣联合皮瓣供区以远全厚皮片修复四肢较大创面的临床效果。方法该研究为回顾性观察性研究。2020年1月—2022年6月，蚌埠医学院第一附属医院收治19例符合入选标准的四肢较大创面患者，其中男15例、女4例，年龄28~75岁。Ⅰ期行清创、骨折复位固定、肌腱血管神经修复和负压封闭引流。Ⅱ期清创后，创面总面积为13.0 cm×8.0 cm~34.0 cm×15.0 cm。采用SCIA浅支穿支皮瓣（面积为10.0 cm×6.5 cm~15.0 cm×8.0 cm）修复肌腱、骨外露处创面（面积为9.0 cm×6.0 cm~14.0 cm×7.0 cm），采用皮瓣供区以远全厚皮片（面积为5.0 cm×3.5 cm~13.0 cm×8.0 cm）修复肉芽组织生长良好创面（面积为5.0 cm×3.5 cm~13.0 cm×8.0 cm）。供区创面均经拉拢缝合。记录患者手术时间、手术出血量，术后观察皮瓣和皮片成活情况。随访观察皮瓣和皮片情况、供区瘢痕情况及其对供区功能的影响。末次随访时，采用疗效满意度评分表评价患者对疗效的满意度。结果患者手术时间为2.0~3.5 h，手术出血量为100~320 mL。1例患者术后第2天皮瓣边缘出现瘀斑、静脉危象，经探查后皮瓣成活；其余患者皮瓣均顺利成活。患者皮片均顺利成活。2例患者因后期肥胖导致皮瓣臃肿，术后6个月行皮瓣削薄手术后达到预期效果。随访6~24个月，皮瓣均弹性好、质地软，皮片无磨损、破溃，供区均遗留线性瘢痕但功能未受到影响，患者对疗效均表示满意。结论采用游离SCIA浅支穿支皮瓣联合皮瓣供区以远全厚皮片修复四肢较大创面，安全可靠、创伤小、手术时间短、术后供受区外形和功能良好。
- 外科皮瓣 /
- 穿支皮瓣 /
- 显微外科手术 /
- 四肢 /
- 皮片移植 /
- 创面修复
Abstract: Objective To investigate the clinical effects of free superficial circumflex iliac artery (SCIA) superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities. Methods The study was a retrospective observational study. From January 2020 to June 2022, 19 patients with large wounds in extremities who met the inclusion criteria were admitted to the First Affiliated Hospital of Bengbu Medical College, including 15 males and 4 females, aged 28-75 years. The debridement, fracture reduction and fixation, tendon, vessel, and nerve repair, and vacuum sealing drainage were performed in the first stage surgery. After debridement in the second stage surgery, the total wound area was 13.0 cm×8.0 cm-34.0 cm×15.0 cm. The tendon and bone exposed wound with area of 9.0 cm×6.0 cm-14.0 cm×7.0 cm was repaired with free SCIA superficial branch perforator flap with area of 10.0 cm×6.5 cm-15.0 cm×8.0 cm. The remaining granulation tissue wound with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm was repaired with full-thickness skin graft far from the flap donor site with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm. All the wounds in donor site were sutured. The operation time and amount of bleeding of patients during the surgery were recorded, the survival of flap and skin graft were observed after surgery. During follow-up, the flap and skin graft, scar in the donor site and its effect on donor site function were observed. At the last follow-up, the satisfaction of patients with the efficacy was evaluated by the efficacy satisfaction rating score. Results The operation time of patients was 2.0-3.5 h. The amount of bleeding of patients during the surgery was 100-320 mL. One patient had ecchymosis and venous crisis in the edge of flap on the second day after surgery, and the flap survived after exploration. The flaps of the other patients survived smoothly. The skin grafts of patients all survived smoothly. Two patients had bloated flaps due to obesity in the later stage, and the expected results were achieved after flap thinning surgery 6 months after operation. During the follow-up of 6 to 24 months, the flaps had good elasticity and soft texture, and the skin grafts had no wear or ulceration; linear scars were left in all the donor sites but their functions were not affected. The patients were all satisfied with the efficacy. Conclusions Free SCIA superficial perforator flap combined with full-thickness skin graft far from the donor site was used to repair the large wounds in extremities, which was safe, reliable, and less traumatic and short in operation time, and resulted in good postoperative appearance and function in the donor sites and recipient sites.
- Surgical flaps /
- Perforator flap /
- Microsurgery /
- Extremities /
- Skin grafting /
- Wound repair
刘洋洋：酝酿设计、论文撰写与修改、实施手术、经费支持；吴敏：研究指导；朱军、张宽宽、牛海州：实施手术、采集资料；高许斌、韩仲兵、刘奋斗：数据收集与整理

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1 游离旋髂浅动脉浅支穿支皮瓣联合皮瓣供区以远全厚皮片移植修复例1患者右足脱套伤创面的效果。1A、1B.分别为第1次清创后1周，足背和足底创面情况，创面均清洁，足背创面可见少量肉芽组织，足底创面可见跖骨末端骨外露；1C.于左侧腹股沟设计皮瓣；1D.术后即刻，皮瓣血运良好；1E.采用皮瓣供区以远全厚皮片移植修复剩余足底肉芽组织生长良好创面术后即刻；1F.术后6个月随访，皮瓣颜色红润、外形良好；1G.术后6个月随访，皮片无磨损、破溃；1H.术后6个月随访，供区遗留线性瘢痕

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2 游离旋髂浅动脉浅支穿支皮瓣联合皮瓣供区以远全厚皮片移植修复例2患者碾压致左足背创面的效果。2A.第1次清创后1周，足背创面清洁，可见足背外侧肌腱外露处创面和足背内侧肉芽组织生长良好创面；2B.于左侧腹股沟设计皮瓣，面积为10.5 cm×7.5 cm；2C.术后即刻，皮瓣血运良好；2D.采用皮瓣供区以远全厚皮片移植修复足背内侧肉芽组织生长良好创面术后即刻；2E.供区创面缝合后即刻；2F.术后24个月随访，皮片无磨损、破溃；2G.术后24个月随访，皮瓣颜色红润、外形良好；2H.术后24个月随访，供区遗留线性瘢痕

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参考文献(21)

[1]	董谢平,沈录峰,李振肃,等.游离串联皮瓣在下肢软组织大面积缺损中的应用[J].中国矫形外科杂志,2009,17(24):1888-1889. DOI: 10.3977/j.issn.1005-8478.2009.04.09.
[2]	王珍,金文虎,张子阳,等.旋股外侧动脉分叶皮瓣修复下肢复杂创面的疗效[J].中华创伤杂志,2021,37(8):688-693.DOI: 10.3760/cma.j.cn501098-20210505-00281.
[3]	尹路,宫可同,殷中罡,等.游离穿支皮瓣联合游离植皮修复足踝部软组织缺损的疗效观察[J].中国修复重建外科杂志,2017,31(3):319-322.DOI: 10.7507/1002-1892.201610122.
[4]	晏桂明,王小立,刘宏国,等.“泳裤供区”的髂腹股沟皮瓣修复手背侧及虎口区皮肤软组织缺损的临床应用[J].实用手外科杂志,2019,33(2):171-173.DOI: 10.3969/j.issn.1671-2722.2019.02.014.
[5]	HussainT, KhanFH, RahmanOU,et al. Superficial circumflex iliac artery free flap for coverage of hand injuries[J]. Cureus,2022,14(11):e31520. DOI: 10.7759/cureus.31520.
[6]	王海文.腹股沟皮瓣的形式及其临床应用[J].中华显微外科杂志,2020,43(2):205-208,插页2-1-插页2-2.DOI: 10.3760/cma.j.cn441206-20200213-00054.
[7]	PereiraN, VenegasJ, OñateV,et al. Extremity reconstruction with superficial circumflex iliac artery perforator free flap: refinements and innovations after 101 cases[J]. J Plast Reconstr Aesthet Surg,2023,85:1-9.DOI: 10.1016/j.bjps.2023.06.048.
[8]	刘林峰,臧成五,丛锐.应用旋髂浅动脉浅支为蒂的穿支皮瓣修复手部皮肤缺损[J].中华手外科杂志,2020,36(2):140-141.DOI: 10.3760/cma.j.cn311653-20190628-00186.
[9]	刘洋洋,吴敏,高许斌,等.动脉端端吻合与端侧吻合法在旋髂浅动脉浅支穿支皮瓣移植中的应用[J].中华显微外科杂志,2021,44(5):517-520.DOI: 10.3760/cma.j.cn441206-20210802-00187.
[10]	张浩,张晓东,庾东春,等.应用带蒂皮瓣修复皮肤软组织缺损[J].中华骨科杂志,2012,32(3):260-264.DOI: 10.3760/cma.j.issn.0253-2352.2012.03.013.
[11]	刘峰,张伟,谢卫国,等.微型游离腹股沟穿支皮瓣修复手部小型创面的效果[J].中华烧伤与创面修复杂志,2023,39(10):933-938.DOI: 10.3760/cma.j.cn501225-20230701-00244.
[12]	杨文福,林金贵,吴学军,等.游离腹股沟皮瓣修复小儿手部软组织缺损[J].中华显微外科杂志,2022,45(1):83-86.DOI: 10.3760/cma.jcn441206-20210817-00196.
[13]	贾钟喻,梁高峰,张满盈,等.游离髂腹股沟皮瓣修复𧿹甲皮瓣供区[J].中国修复重建外科杂志,2021,35(4):527-528. DOI: 10.7507/1002-1892.202011018.
[14]	唐林,周鑫,黄波,等.携带腹外斜肌腱膜的髂腹股沟皮瓣修复足背肌腱及皮肤缺损[J].中国修复重建外科杂志,2022,36(2):215-219. DOI: 10.7507/1002-1892.202108132.
[15]	HongJP. The superficial circumflex iliac artery perforator flap in lower extremity reconstruction[J]. Clin Plast Surg,2021,48(2):225-233. DOI: 10.1016/j.cps.2020.12.005.
[16]	AbdelfattahU,ElbanobyT,ElmoftyAM,et al.The durability of thin superficial circumflex iliac artery perforator flap in sole reconstruction: clinical experience with 18 cases[J].Microsurgery,2022,42(8):800-809.DOI: 10.1002/micr.30960.
[17]	杨科跃,黄剑,陈川,等.端侧吻合技术在个性化游离腹股沟皮瓣移植中的应用[J].中华显微外科杂志,2021,44(4):403-407.DOI: 10.3760/cma.j.cn441206-20201119-00389.
[18]	古欣庆,周洋,李孝根,等.腹股沟皮瓣切取技巧及其修复手和足部软组织缺损[J].中华显微外科杂志,2021,44(4):456-459.DOI: 10.3760/cma.j.cn441206-20210329-00089.
[19]	刘洋洋,吴敏,高许斌,等.吻合血管逆行血供的游离穿支皮瓣修复四肢复杂创面[J]. 中国修复重建外科杂志,2022,36(2):260-262. DOI: 10.7507/1002-1892.202108068.
[20]	徐军辉,张伟,周锦秀,等.游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果[J].中华烧伤与创面修复杂志,2023,39(11):1030-1037.DOI: 10.3760/cma.j.cn501225-20230804-00039.
[21]	SunJM,YamamotoT,GohTL.Venous anatomy of the superficial circumflex iliac artery perforator flap: a cadaveric and clinical study[J].J Plast Reconstr Aesthet Surg,2023,88:1-7.DOI: 10.1016/j.bjps.2023.10.096.