携带浅静脉的游离骨间后动脉穿支皮瓣整复口周严重瘢痕增生挛缩的临床效果

张海瑞; 张栋梁; 闫晓慧; 张晓鹏; 尚旭亮; 孟艳斌

doi:10.3760/cma.j.cn501225-20231031-00162

携带浅静脉的游离骨间后动脉穿支皮瓣整复口周严重瘢痕增生挛缩的临床效果

doi: 10.3760/cma.j.cn501225-20231031-00162

1.
太钢总医院（山西医科大学第六医院）烧伤科，山西省烧伤救治中心，太原　　030009
2.
空军军医大学第一附属医院全军烧伤中心，烧伤与皮肤外科，西安　　710032
3.
昔阳县医疗集团人民医院骨科，昔阳　　045300

基金项目:

国家自然科学基金青年科学基金项目 81901980

详细信息

通讯作者:
孟艳斌，Email：m64225@163.com

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出版历程
- 收稿日期: 2023-10-31
- 网络出版日期: 2023-12-19

Clinical effect of free posterior interosseous artery perforator flap carrying superficial vein for reconstructing severe perioral scar hyperplasia and contracture

1.
Institute of Burns, General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University), Taiyuan 030009, China
2.
Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
3.
Department of Orthopedics, Xiyang County Medical Group People's Hospital, Xiyang 045300, China

Funds:

Youth Science Foundation Program of National Natural Science Foundation of China 81901980

More Information

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

摘要

摘要: 目的观察携带浅静脉的游离骨间后动脉穿支皮瓣整复口周严重瘢痕增生挛缩的临床效果。方法采用回顾性观察性研究方法。2019年8月—2023年3月，太钢总医院（山西医科大学第六医院）收治11例符合入选标准的面部严重烧伤后口周严重瘢痕增生挛缩的患者，均为男性，年龄23~56岁（平均31.3岁）。切除松解口周瘢痕后，创面面积为3.0 cm×2.0 cm~10.5 cm×2.0 cm。采用携带浅静脉的游离骨间后动脉穿支皮瓣修复创面，皮瓣切取面积为3.5 cm×2.5 cm~11.0 cm×2.5 cm。其中6例患者因需同时修复同侧上、下唇周瘢痕切除后的创面，对皮瓣行分叶处理。直接缝合供瓣区创面。术后观察皮瓣成活情况及血管危象发生情况。术后随访时，观察皮瓣外形、质地、色泽，皮瓣供区外观，以及患者口歪、流涎、张口受限、唇外翻改善情况。结果所有患者术后皮瓣均完全成活，无血管危象发生。术后随访6~36个月，皮瓣无明显臃肿，质地柔软，与面部正常皮肤色泽相近，供瓣区仅遗留线性瘢痕，口歪、流涎、张口受限及唇外翻明显好转。结论采用携带浅静脉的游离骨间后动脉穿支皮瓣整复严重口周瘢痕增生挛缩，术后皮瓣血管危象发生率低，对皮瓣行分叶处理可同时修复单侧上、下唇周创面，术后患者口周外观及功能有明显改观，该皮瓣是整复小面积口周严重瘢痕增生挛缩的较佳选择。
- 瘢痕 /
- 显微外科手术 /
- 外科皮瓣 /
- 穿支皮瓣 /
- 口周
Abstract: Objective To observe the clinical effect of free posterior interosseous artery perforator flap carrying superficial vein for reconstructing severe perioral scar hyperplasia and contracture. Methods The retrospective observational study method was used. From August 2019 to March 2023, 11 patients with severe perioral scar hyperplasia and contracture after severe facial burns who met the inclusion criteria were admitted to General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients were male and aged 23 to 56 years, with an average age of 31.3 years. After the perioral scar was removed and released, the wound area was 3.0 cm×2.0 cm to 10.5 cm×2.0 cm. The free posterior interosseous artery perforator flap carrying superficial vein was used to repair the wound, and the flap incision area was 3.5 cm×2.5 cm to 11.0 cm×2.5 cm. Among them, 6 patients required repair of wounds after resecting scar around ipsilateral upper and lower lips, and the lobular treatment of the flap was conducted. The wound in the flap donor area was directly sutured. After surgery, the survival of the flap and the occurrence of vascular crisis were observed. During follow-up after surgery, the appearance, texture, and color of the flap, the appearance of the flap donor area, and improvements of crooked mouth, drooling, limited mouth opening, and lip valgus in patients were observed. Results All the flaps in patients completely survived after surgery, with no occurrence of vascular crisis. During follow-up of 6 to 36 months after surgery, the flap was not significantly bloated, was soft in texture, and had a similar color to that of the normal facial skin. Only linear scars were left in the flap donor area, and crooked mouth, drooling, limited mouth opening, and lip valgus in patients were significantly improved. Conclusions The free posterior interosseous artery perforator flap carrying superficial vein can reconstruct severe perioral scar hyperplasia and contracture, with low incidence of postoperative flap vascular crisis, and the lobular treatment of flaps can repair wounds around unilateral upper and lower lips at the same time. After surgery, the appearance and function of the perioral area are significantly improved. The flap is a good choice for repairing small area of severe perioral scar hyperplasia and contracture.
- Cicatrix /
- Microsurgery /
- Surgical flaps /
- Perforator flap /
- Perioral area
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参考文献(24)

[1]	李莉,刘建宇,曹志红,等.双蒂额部扩张皮瓣治疗面部烧伤后口周瘢痕挛缩15例[J].中华创伤杂志,2014,30(1):47-48.DOI: 10.3760/cma.j.issn.1001-8050.2014.01.013.
[2]	蒋朔,常兴华,张晨,等.东方女性面部美学标准的量化[J].中华整形外科杂志,2011,27(2):151-154.DOI: 10.3760/cma.j.issn.1009-4598.2011.02.027.
[3]	常宏,唐银科,楚菲菲,等.扩张后皮瓣治疗口周瘢痕的几种方法探讨[J].中华整形外科杂志,2022,38(10):1119-1127.DOI: 10.3760/cma.j.cn114453-20211108-00434.
[4]	杨果凡,陈宝驹,高玉智,等.前臂皮瓣游离移植术(附56例报告)[J].中华医学杂志,1981,61(3):139-141.
[5]	刘晓燕,陶凯,梁久龙,等.前臂皮瓣显微游离移植技术发明的里程碑意义[J].中国美容整形外科杂志,2019,30(9):508-512.DOI: 10.3969/j.issn.1673-7040.2019.09.001.
[6]	王占统,丁健科,余州,等.扩张术修复头面部瘢痕的临床应用进展[J].中华实验外科杂志,2020,37(7):1379-1383.DOI: 10.3760/cma.j.cn421213-20191230-00925.
[7]	SongB,ZhaoJ,GuoS,et al.Repair of facial scars by the free expanded deltopectoral flap[J].Plast Reconstr Surg,2013,131(2):200e-208e.DOI: 10.1097/PRS.0b013e3182789c02.
[8]	吴春,王正理,谭莉,等.携带浅静脉的骨间后动脉双叶穿支皮瓣修复两指软组织缺损[J].中华手外科杂志,2019,35(3):224-225.DOI: 10.3760/cma.j.issn.1005-054X.2019.03.022.
[9]	侯春林, 顾玉东. 皮瓣外科学[M].上海: 上海科学技术出版社, 2019: 534.
[10]	王欣,胡浩良,王胜伟,等.前臂骨间后动脉穿支皮瓣的解剖学研究[J].解剖与临床,2011,16(1):69-70.DOI: 10.3969/j.issn.1671-7163.2011.01.023.
[11]	ZaidenbergEE,ZancolliP,Farias CisnerosE,et al.Antegrade posterior interosseous flap for nonhealing wounds of the elbow: anatomical and clinical study[J].Plast Reconstr Surg Glob Open,2018,6(11):e1959.DOI: 10.1097/GOX.0000000000001959.
[12]	周维,李学渊,胡浩良.高频超声辅助下前臂中下段游离骨间后动脉穿支皮瓣修复手指软组织缺损[J].中华显微外科杂志,2020,43(3):285-288.DOI: 10.3760/cma.j.cn441206-20200216-00062.
[13]	孙超,王增涛,侯致典,等.骨间后动脉皮支链皮瓣的应用解剖[J].中华显微外科杂志,2012,35(1):46-49.DOI: 10.3760/cma.j.issn.1001-2036.2012.01.018.
[14]	魏苏明,陆征峰,刘宇舟,等.游离骨间后动脉双皮瓣移植修复两指软组织缺损[J].中华显微外科杂志,2019,42(1):59-61.DOI: 10.3760/cma.j.issn.1001-2036.2019.01.016.
[15]	南利民,赵森,赵立宗,等.骨间后动脉游离穿支皮瓣移植修复手指皮肤软组织缺损[J].实用手外科杂志,2020,34(4):387-390.DOI: 10.3969/j.issn.1671-2722.2020.04.006.
[16]	陆浩,薛明宇,强力,等.以骨间后动脉穿支为蒂的V-Y接力皮瓣修复手背部创面[J].中华手外科杂志,2023,39(1):40-43.DOI: 10.3760/cma.j.cn311653-20220317-00073.
[17]	RobinsonLP,UsmaniRH,HazelA,et al.Use of the antegrade posterior interosseous artery flap for coverage of complex elbow wounds[J].Plast Reconstr Surg,2021,148(6):1316-1319.DOI: 10.1097/PRS.0000000000008578.
[18]	AbdelfattahU,PowerHA,SongS,et al.Algorithm for free perforator flap selection in lower extremity reconstruction based on 563 cases[J].Plast Reconstr Surg,2019,144(5):1202-1213.DOI: 10.1097/PRS.0000000000006167.
[19]	ZhouX, HuD, LuH, et al. Sequential posterior interosseous artery perforator flap for reconstruction of dorsal hand defects[J]. Clin Anat, 2022,35(8):1114-1122. DOI: 10.1002/ca.23922.
[20]	KameiW, MurakamiM, NakamotoK, et al. Spare parts surgery with a free posterior interosseous artery perforator flap for thumb tip[J]. Plast Reconstr Surg Glob Open, 2021, 9(6):e3624. DOI: 10.1097/GOX.0000000000003624.
[21]	蔡晓明,王欣,张健,等.游离前臂骨间后动脉分叶穿支皮瓣修复指体软组织缺损[J].中华整形外科杂志,2017,33(5):387-389.DOI: 10.3760/cma.j.issn.1009-4598.2017.05.015.
[22]	方鑫,胡沣,陈前永,等.前臂游离骨间后动脉分叶穿支皮瓣修复多指软组织缺损[J].创伤外科杂志,2022,24(6):420-423.DOI: 10.3969/j.issn.1009-4237.2022.06.005.
[23]	张驰,孙广峰,游兴,等.游离骨间后动脉穿支皮瓣在小面积手部皮肤软组织缺损中的应用[J].中华整形外科杂志,2021,37(9):1007-1012.DOI: 10.3760/cma.j.cn114453-20210316-00115.
[24]	肖媚媚,谢松林,肖湘君.游离骨间后动脉四叶皮瓣联合甲瓣修复单手5指指背软组织缺损一例[J].中华显微外科杂志,2022,45(5):588-590.DOI: 10.3760/cma.j.cn441206-20220729-00160.

1 游离移植左前臂骨间后动脉穿支双叶皮瓣整复患者火焰烧伤后口周严重瘢痕增生挛缩。1A.术前见右上、下唇周瘢痕增生挛缩，口周瘢痕牵拉，张口受限，上、下唇外翻；1B.术前按右口周瘢痕切除松解后的创面设计双叶皮瓣；1C.术中显露小指固有伸肌腱与尺侧腕伸肌腱肌间隙；1D.术中皮瓣切取后；1E.将双叶皮瓣移植于口周瘢痕切除后创面并缝合后即刻；1F.术后随访7个月，口周外形明显改善

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