游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果

徐军辉; 张伟; 周锦秀; 陈斓; 张卫东; 龚翔; 谢卫国

doi:10.3760/cma.j.cn501225-20230804-00039

游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果

doi: 10.3760/cma.j.cn501225-20230804-00039

武汉大学同仁医院暨武汉市第三医院烧伤科，武汉　　430060

基金项目:

武汉市临床医学科研项目 WX20Q18

武汉市科技局知识创新专项曙光计划项目 2022020801020553

详细信息

通讯作者:
张伟，Email：zhw010@163.com

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出版历程
- 收稿日期: 2023-08-04

Clinical effects of free transplantation of inguinal flap in repairing electrical burn wounds of mice in the limbs

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

Funds:

Clinical Medical Research Project of Wuhan WX20Q18

Knowledge Innovation Program of Wuhan-Shugung Project 2022020801020553

More Information

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

摘要

摘要: 目的探讨游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果。方法采用回顾性观察性研究方法。2012年1月—2023年5月，武汉大学同仁医院暨武汉市第三医院烧伤科收治24例符合入选标准的年龄20~69岁四肢电烧伤男性患者。共27个肢体受累，其中上肢18个、下肢9个。清创后，肢体拟用腹股沟皮瓣修复的创面面积为5.0 cm×1.5 cm~20.0 cm×9.0 cm。对24例患者共行26次手术，切取27个面积为5.0 cm×3.5 cm~22.0 cm×12.0 cm游离腹股沟皮瓣，其中6个行分叶移植，2个与髂骨瓣嵌合移植，3个与带蒂背阔肌肌皮瓣联体移植，1个与游离脐旁穿支皮瓣联体移植。术中行吲哚菁绿血管造影评估腹股沟皮瓣血运，指导移植时动脉增压。移植的腹股沟皮瓣中，5个以旋髂浅动脉与腹壁浅动脉共干为血管蒂，13个以单纯旋髂浅动脉为血管蒂，6个以单纯腹壁浅动脉为血管蒂，其余3个同时吻合旋髂浅动脉和腹壁浅动脉行动脉增压。另对1例患者用旋髂浅动脉的深支作为桥接血管再通示指远节固有动脉。将供区创面直接缝合。记录腹股沟皮瓣切取完毕切断血管前与移植并吻合血管后即刻的血运状态，术后观察组织瓣成活情况、移植髂骨固定情况、供区继发缺损愈合情况，随访观察腹股沟皮瓣外观、受区功能恢复情况。末次随访时，采用臂、肩、手残障（DASH）评分表对受累上肢功能进行评分，参考利克特量表5级评分法调查患者对每次手术治疗效果的满意度。结果 27个腹股沟皮瓣切取完毕切断血管前与移植并吻合血管后即刻动脉血流灌注与静脉回流均良好。除1个腹股沟皮瓣术后12 d出现坏死，经头部刃厚皮移植修复外，其余26个腹股沟皮瓣及联体移植组织瓣术后完全成活，未发生血管危象；移植髂骨术后固定牢靠；供区继发缺损术后均愈合良好。随访6~36个月，腹股沟皮瓣质地柔软，无明显臃肿；受区功能均较术前明显改善，腹股沟皮瓣均恢复保护性感觉。末次随访时，18个受累上肢功能的DASH评分表评分为0~100分（平均27分），患者对17次手术治疗效果表示非常满意、对9次手术治疗效果表示比较满意。结论腹股沟皮瓣供区位置隐蔽，于该处切取皮瓣造成的损伤小，该皮瓣血供丰富，将其分叶移植、嵌合移植、与其他皮瓣联体移植等修复四肢电烧伤创面后，受区外形与功能恢复较佳，患者对手术治疗效果的满意度较高，值得临床推广。
- 烧伤，电 /
- 外科皮瓣 /
- 腹股沟 /
- 游离皮瓣 /
- 供区保护 /
- 四肢功能 /
- 创面修复
Abstract: Objective To investigate the clinical effects of free transplantation of inguinal flap in repairing electrical burn wounds of mice in the limbs. Methods A retrospective observational study was conducted. From January 2012 to May 2023, 24 male patients with electrical burns in the limbs meeting the inclusion criteria, aged 20 to 69 years, were admitted to the Department of Burns of Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital. Totally 27 limbs were involved, including 18 upper limbs and 9 lower limbs. After debridement, the wound area in the limbs proposed to be repaired with the inguinal flap was 5.0 cm×1.5 cm-20.0 cm×9.0 cm. A total of 26 operations were performed in 24 patients, and 27 free inguinal flaps with area being 5.0 cm×3.5 cm-22.0 cm×12.0 cm were resected, including 6 for lobed transplantation, 2 for chimeric transplantation with iliac bone graft, 3 for conjoined transplantation with pedicled latissimus dorsi myocutaneous flap, and 1 for conjoined transplantation with free paraumbilical perforator flap. Indocyanine green angiography was used to evaluate the blood supply of the inguinal flap during operation, to guide arterial supercharge during transplantation. Among the transplanted inguinal flaps, 5 were pedicled with the common trunk of the superficial circumflex iliac artery and the superficial abdominal wall artery, 13 were pedicled with the superficial circumflex iliac artery alone, 6 were pedicled with the superficial abdominal wall artery alone, and the remaining 3 were simultaneously anastomosed with the superficial circumflex iliac artery and the superficial abdominal wall artery for arterial supercharge. In another patient, the deep branch of the superficial circumflex iliac artery was used as a bridging vessel to recanalize the proper artery of the index finger in the distal segment. The wound in the donor area were sutured directly. The blood supply status of the inguinal flap immediately after resection but before cutting off blood vessels and after transplantation and vascular anastomosis was recorded. The survival of the tissue flap, the fixation of the iliac bone graft, and the healing of secondary defect in the donor area were observed after surgery. The appearance of the inguinal flap and the functional recovery of the recipient area were followed up. At the last follow-up, the function of the affected upper limb was scored using the Arm, Shoulder, and Hand Disability (DASH) scoring scale, and the satisfaction of patients with the efficacy of each surgical treatment was investigated by referring to the 5-level Likert scale. Results Totally 27 inguinal flaps showed good arterial blood perfusion and venous return immediately after resection but before cutting off blood vessels and after transplantation and vascular anastomosis. Except for one inguinal flap that developed necrosis 12 days after operation and was repaired by split-thickness skin graft from the head, the remaining 26 inguinal flaps and conjointly transplanted tissue flaps survived completely without vascular crisis. The iliac bone graft was fixed securely after operation. All secondary defects in donor area healed well after operation. After 6 to 36 months of follow-up, the inguinal flap was soft in texture, without obvious swelling, the function of the recipient area was significantly improved as compared with that before surgery, and the protective feeling of the inguinal flap was restored. At the last follow-up, the functional scores of DASH scoring scale of the 18 affected upper limbs ranged from 0 to 100 (with a mean of 27). The patients were very satisfied with the efficacy of 17 surgical treatments and relatively satisfied with the efficacy of 9 surgical treatments. Conclusions The donor area of the inguinal flap is concealed, and the damage resulted from flap resection in this area is small. This flap has a rich blood supply. In the electrical burn wounds of mice in the limbs repaired with lobed transplantation, chimeric transplantation, and conjoined transplantation with other flaps, the appearance and function of the recipient area are well restored, and the patients' satisfaction with the efficacy of surgical treatment is high, which is worthy of clinical promotion.
- Burns, electric /
- Surgical flaps /
- Groin /
- Free flap /
- Protection of donor area /
- Limb function /
- Wound repair
徐军辉、张伟：论文撰写与修改；周锦秀、陈斓、张卫东、龚翔：数据收集与整理；谢卫国：研究指导

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1 游离移植双侧腹股沟皮瓣修复例1患者双手电烧伤创面并桥接右手示指远节固有动脉的效果。1A.术前左手电烧伤创面；1B.术前右手电烧伤创面；1C.术前吲哚菁绿血管造影显示，右手示指末节无血流灌注（箭头所示）；1D.切取左侧腹股沟皮瓣，解剖出旋髂浅动脉的深支（箭头所示）备用；1E.游离移植皮瓣修复右手示指并桥接远节动脉术后即刻；1F.右手示指创面修复后即刻吲哚菁绿血管造影显示，皮瓣血流灌注良好；1G.设计右侧腹股沟分叶皮瓣；1H.切取右侧腹股沟皮瓣并分叶后即刻吲哚菁绿血管造影显示，皮瓣血流灌注良好；1I.术后2年，右手示指创面愈合良好，外形佳；1J.术后2年，左手创面愈合良好；1K.术后2年，右手指屈功能正常；IL.术后2年，左手除示指外指屈功能正常

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2 游离移植右侧腹股沟分叶皮瓣嵌合髂骨瓣修复例2患者右足电烧伤创面的效果。2A.术中清创后，右足第1趾远节切除后；2B、2C.分别为右侧腹股沟皮瓣嵌合髂骨瓣术前设计、术中切取时；2D.切取右侧腹股沟皮瓣嵌合髂骨瓣且行皮瓣分叶后，箭头指示髂骨瓣；2E.用组织瓣修复右足创面后即刻；2F.术后8个月，右足创面愈合良好

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