旁路静脉桥接在游离股前外侧皮瓣修复头部高压电烧伤创面中的临床应用效果

邢培朋; 薛继东; 郭海娜; 马超; 赵孝开; 梁占领; 董国赟; 狄海萍; 夏成德

doi:10.3760/cma.j.cn501225-20240419-00142

旁路静脉桥接在游离股前外侧皮瓣修复头部高压电烧伤创面中的临床应用效果

doi: 10.3760/cma.j.cn501225-20240419-00142

郑州市第一人民医院烧伤科,郑州　　450004

基金项目:

国家临床重点专科建设项目 2023-70

河南省医学科技攻关计划联合共建项目 LHGJ20190999

详细信息

通讯作者:
夏成德,Email：308591645@qq.com

计量
- 文章访问数: 126
- HTML全文浏览量: 29
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2024-04-19

Clinical application effect of bypass vein bridging in repairing high-voltage electric burn wounds on the head with free anterolateral thigh flaps

Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China

Funds:

National Clinical Key Specialty Construction Project of China 2023-70

Joint Construction Project of Henan Medical Science and Technology Research Plan LHGJ20190999

More Information

Corresponding author: Xia Chengde, Email: 308591645@qq.com

摘要

摘要: 目的探讨旁路静脉桥接在游离股前外侧皮瓣修复头部高压电烧伤创面中的临床应用效果。方法该研究为回顾性观察性研究。2017年5月—2022年12月,郑州市第一人民医院收治8例符合入选标准的头部高压电烧伤患者,其中男6例、女2例,年龄33~73岁,均有颅骨外露,其中3例患者颅骨大面积缺损,1例患者左眼坏死,3例患者脑出血。清创后头部创面面积为13 cm×7 cm~21 cm×15 cm,切取面积为14 cm×8 cm~22 cm×16 cm的游离股前外侧皮瓣进行修复。将皮瓣携带的旋股外侧动脉降支主干与受区颞浅动脉端端吻合；将皮瓣吻合动脉的一条伴行静脉通过桥接大隐静脉与颈外静脉属支端端吻合,另一条伴行静脉与受区颞浅静脉端端吻合。将供区创面直接拉拢缝合或移植大腿内侧中厚皮片封闭。术后观察皮瓣血运、成活情况和头部创面愈合情况,记录术后2周内应用彩色超声诊断系统观察到的移植静脉血管血流情况及管腔充盈情况,记录皮瓣供区创面修复方式并观察皮瓣供区创面愈合情况。随访观察皮瓣及其供区的外观、皮瓣供区所在下肢肌力,以及患者能否用皮瓣供区所在下肢完成站立、行走及下蹲。结果术后8例患者皮瓣均成活,均未发生动脉危象或静脉危象；5例患者头部创面术后愈合,3例患者头部创面因术后2周皮瓣下方有分泌物渗出于术后21~35 d再次行清创术后愈合。术后2周内,移植静脉血管持续通畅,超声探头加压后移植静脉可被压瘪,松开探头后血管迅速充盈。3例患者皮瓣供区创面被直接拉拢缝合,术后2周愈合；5例患者皮瓣供区创面为移植大腿内侧中厚皮片封闭,术后12 d皮片全部成活。随访6~12个月,所有患者头部皮瓣轻度臃肿,无毛发生长；供区遗留轻度线性或片状瘢痕增生,所有皮瓣供区所在下肢肌力正常、无减退,患者能用皮瓣供区所在下肢完成站立、行走及下蹲。结论在应用游离股前外侧皮瓣修复各种面积、深度的头部高压电烧伤创面时进行旁路静脉桥接,可减少术后皮瓣静脉危象的发生,术后创面愈合质量高,皮瓣供区所在下肢功能不受影响。
- 烧伤,电 /
- 头部 /
- 外科皮瓣 /
- 显微外科手术 /
- 股前外侧皮瓣 /
- 静脉移植 /
- 旁路静脉桥接
Abstract: Objective To investigate the clinical application effect of bypass vein bridging in repairing high-voltage electric burn wounds on the head with free anterolateral thigh flaps. Methods This study was a retrospective observational study. From May 2017 to December 2022, 8 patients with high-voltage electric burns on the head who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 6 males and 2 females, aged 33 to 73 years. All patients had skull exposure, including 3 cases of large skull defect, 1 case of left eye necrosis, and 3 cases of cerebral hemorrhage. After debridement, the head wound area was from 13 cm×7 cm to 21 cm×15 cm, and the free anterolateral thigh flap with the area of 14 cm×8 cm to 22 cm×16 cm was cut for repair. The main descending branch of the lateral circumflex femoral artery carried by the flap was anastomosed end-to-end with the superficial temporal artery in the recipient area. One accompanying vein of the anastomotic artery of the flap was end-to-end anastomosed with the branch of the external jugular vein via great saphenous vein bridging, and the other accompanying vein was end-to-end anastomosed with the superficial temporal vein in the recipient area. The donor site wounds were directly sutured or closed with medium-thickness skin grafts from inner thigh. The blood supply and survival of the flap, and the wound healing on the head were observed after operation. The blood flow and lumen filling of the transplanted vein were observed and recorded by using color ultrasound diagnostic system within 2 weeks after operation. The wound repair method and wound healing of the flap donor site were recorded and observed. Patients were followed up to observe the appearance of the flaps and the flap donor sites, the muscle strength of the lower limbs where the flap donor site was located, and whether the patient could complete standing, walking, and squatting using the lower limbs where the flap donor site was located. Results The flaps of 8 patients survived after operation, and no arterial or venous crisis occurred. The wounds of 5 patients on the head healed after operation, and the wounds of 3 patients on the head healed after second debridement 21 to 35 days after operation due to exudates under the flap 2 weeks after operation. Within 2 weeks after operation, the grafted vein continued to be unobstructed. After the ultrasound probe was pressurized, the grafted vein could be deflated, and the blood vessels were rapidly filled after the probe was released. The wounds of flap donor sites of 3 patients were directly sutured and healed 2 weeks after operation. The wounds of flap donor sites of 5 patients were closed with medium-thickness skin grafts from inner thigh, and all the skin grafts survived 12 days after operation. During follow-up of 6 to 12 months, the head flaps of all patients were slightly bloated without hair growth. Mild linear or patchy scar hyperplasia was left in the donor site. The muscle strength of the lower limbs where the flap donor site was located was normal and did not decrease. The patients could stand, walk, and squat with the lower limbs where the flap donor site was located. Conclusions When using the free anterolateral thigh flap to repair high-voltage electric burn wounds of various areas and depths on the head, bypass vein bridging can reduce the occurrence of postoperative flap vein crisis and improve the quality of postoperative wound healing without affecting the function of the lower limbs where the flap donor site is located.
- Burns, electric /
- Head /
- Surgical flaps /
- Microsurgery /
- Anterolateral thigh flap /
- Venous transplantation /
- Bypass vein bridging
邢培朋、薛继东、狄海萍、夏成德：手术设计和操作、文章撰写、病历资料的整理及分析；郭海娜、赵孝开、梁占领、董国赟：患者管理、手术操作、资料收集；马超：论文修改

所有作者均声明不存在利益冲突

HTML全文

参考文献(31)

[1]	郭鹏飞,王旭,魏爱周,等.基于供区保护理念的游离股前外侧分叶穿支皮瓣在头部电烧伤创面修复中的临床应用效果[J].中华烧伤与创面修复杂志,2022,38(1):77-80.DOI: 10.3760/cma.j.cn501120-20201111-00470.
[2]	田淑芳,顾帅鹏,赵炎,等.高压电烧伤致大面积头皮缺损、颅骨外露创面修复1例[J].中华整形外科杂志,2023,39(6):610-613.DOI: 10.3760/cma.j.cn114453-20220927-00299.
[3]	龚健,邱逦.高频彩超评估股前外侧皮瓣穿支血管及相关影响因素分析[J].中国超声医学杂志,2019,35(8):738-741.DOI: 10.3969/j.issn.1002-0101.2019.08.023.
[4]	李振洲,李泉水.高频彩超在深度电烧伤诊断与治疗中的应用[J].临床超声医学杂志,2005,7(4):268-269.DOI: 10.3969/j.issn.1008-6978.2005.04.017.
[5]	刘小俊,武彬,姚毅.双侧旋转皮瓣在头皮缺损创面修复中的应用[J/CD].中华损伤与修复杂志(电子版),2015,10(5):42-43.DOI: 10.3877/cma.j.issn.1673-9450.2015.05.010.
[6]	DalayC,KesiktasE,YavuzM,et al.Coverage of scalp defects following contact electrical burns to the head: a clinical series[J].Burns,2006,32(2):201-207.DOI: 10.1016/j.burns.2005.08.010.
[7]	MaierMA,PalinesPA,GuidryRF,et al.Use of flow-through free flaps in head and neck reconstruction[J].Plast Reconstr Surg Glob Open,2024,12(3):e5588.DOI: 10.1097/GOX.0000000000005588.
[8]	覃凤均,陈旭,陈忠,等.头部电烧伤合并颅骨全层坏死、缺损八例的治疗总结[J/CD].中华损伤与修复杂志(电子版),2013,8(6):42-44.DOI: 10.3877/cma.j.issn.1673-9450.2013.06.012.
[9]	夏成德,薛继东,邢培朋,等.颞浅动脉顶支带蒂头皮瓣修复面部毁损性烧伤创面的临床效果[J].中华烧伤与创面修复杂志,2023,39(10):919-925.DOI: 10.3760/cma.j.cn501225-20230312-00077.
[10]	王凌峰,张军,巴特,等.颈横动脉为蒂的斜方肌肌皮瓣修复头颈部电烧伤二例[J].中华烧伤杂志,2009,25(1):29-30.DOI: 10.3760/cma.j.issn.1009-2587.2009.01.013.
[11]	LiY,ZhaoZ,WuD,et al.Clinical application of supraclavicular flap for head and neck reconstruction[J].Eur Arch Otorhinolaryngol,2019,276(8):2319-2324.DOI: 10.1007/s00405-019-05483-9.
[12]	CoruhA.High voltage electric burn repair of the forehead by reverse flow temporalis muscle flap[J].J Burn Care Res,2019,40(3):373-376.DOI: 10.1093/jbcr/irz024.
[13]	杨勇,刘德贵,李晋,等.皮肤扩张术修复头皮电烧伤伴颅骨坏死失败的教训[J].中华整形烧伤外科杂志,1997,13(6):413.DOI: 10.3760/cma.j.issn.1000-7806.1997.06.105.
[14]	唐鑫成,邹永根,欧昌良,等.游离股前外侧皮瓣修复电击伤后头部大面积软组织缺损[J].中华显微外科杂志,2021,44(2):178-180.DOI: 10.3760/cma.j.cn441206-20200730-00307.
[15]	蔡旭,喻建军,李赞,等.游离股前外侧皮瓣与改良胸大肌皮瓣在修复头颈肿瘤术后缺损中的选择与改进[J].中华整形外科杂志,2020,36(3):284-288.DOI: 10.3760/cma.j.cnZHZXWKZZ-2018-0313-00122.
[16]	邢培朋,郭海娜,狄海萍,等.游离股前外侧皮瓣联合动脉血管重建修复腕部高压电烧伤创面的临床效果[J].中华烧伤杂志,2020,36(6):419-425.DOI: 10.3760/cma.j.cn501120-20200219-00067.
[17]	徐家钦,邱勋永,潘云川,等.应用游离穿支皮瓣修复头部电烧伤创面六例[J].中华显微外科杂志,2014,37(3):282-284.DOI: 10.3760/cma.j.issn.1001-2036.2014.03.026.
[18]	李海,刘志远,聂开瑜,等.自体血管移植桥接巨大旋股外侧动脉穿支皮瓣修复头部大面积皮肤软组织缺损[J].中华创伤杂志,2021,37(12):1074-1077.DOI: 10.3760/cma.j.cn501098-20210816-00439.
[19]	梁尊鸿,潘云川,林志琥,等.游离股前外侧皮瓣及头皮扩张术序贯治疗头皮大面积缺损并颅骨外露感染创面[J].中华显微外科杂志,2018,41(2):186-189.DOI: 10.3760/cma.j.issn.1001-2036.2018.02.024.
[20]	杨晓敏,何永静,张娟,等.背阔肌肌皮瓣和股前外侧皮瓣游离移植修复头皮鳞状细胞癌术后创面的效果观察[J].中华整形外科杂志,2021,37(4):418-422.DOI: 10.3760/cma.j.cn114453-20200305-00113.
[21]	杨力,薛君荣,蒋鹏,等.游离背阔肌肌皮瓣修复头部复合组织缺损创面[J].中华整形外科杂志,2019,35(10):991-994.DOI: 10.3760/cma.j.issn.1009-4598.2019.10.008.
[22]	赵书明,刘娜,刘学亮,等.彩色多普勒超声辅助下超薄胸背动脉穿支皮瓣的切取方案及临床应用效果[J].中华烧伤与创面修复杂志,2024,40(3):281-288.DOI: 10.3760/cma.j.cn501225-20231012-00111.
[23]	李晓庆,王欣,韩亚龙,等.CT血管造影联合股前外侧穿支皮瓣加阔筋膜移植修复伴颅骨坏死外露头部电烧伤创面的效果[J].中华烧伤杂志,2018,34(5):283-287.DOI: 10.3760/cma.j.issn.1009-2587.2018.05.006.
[24]	BoissiereF,GandolfiS,RiotS,et al.Flap venous congestion and salvage techniques: a systematic literature review[J].Plast Reconstr Surg Glob Open,2021,9(1):e3327.DOI: 10.1097/GOX.0000000000003327.
[25]	韩夫,郑朝,王洪涛,等.带阔筋膜股前外侧游离皮瓣修复头部鳞状细胞癌切除后硬脑膜缺损的效果[J].中华烧伤杂志,2020,36(3):219-223.DOI: 10.3760/cma.j.cn501120-20190505-00222.
[26]	钟怡鸣,孙焕伟,陈东,等.携带阔筋膜的股前外侧穿支皮瓣修复头皮及硬脑膜缺损八例[J].中华显微外科杂志,2022,45(5):552-556.DOI: 10.3760/cma.j.cn441206-20220319-00055.
[27]	WrightEO,RahmanS.One versus two veins in free anterolateral thigh flap reconstruction: a systematic review and meta-analysis[J].Cureus,2022,14(12):e32358.DOI: 10.7759/cureus.32358.
[28]	RiotS,HerlinC,MojallalA,et al.A systematic review and meta-analysis of double venous anastomosis in free flaps[J].Plast Reconstr Surg,2015,136(6):1299-1311.DOI: 10.1097/PRS.0000000000001791.
[29]	胡朝波,裴世杰,孔令福,等.血管增压和超回流技术在游离股前外侧皮瓣中的临床应用[J].中华显微外科杂志,2023,46(3):241-246.DOI: 10.3760/cma.j.cn441206-20220417-00076.
[30]	张驰,游兴,吕美娟,等.超回流技术在逆行股前外侧斜支皮瓣修复小腿上段软组织缺损的应用[J].中华显微外科杂志,2019,42(3):209-212.DOI: 10.3760/cma.j.issn.1001-2036.2019.03.001.
[31]	卿黎明,贺继强,唐举玉,等.旋股外侧动脉降支穿支皮瓣供区直接闭合的可靠切取宽度及其影响因素分析[J].中华显微外科杂志,2017,40(2):114-117.DOI: 10.3760/cma.j.issn.1001-2036.2017.02.003.

下载: 全尺寸图片幻灯片

图 1 采用游离股前外侧皮瓣修复患者头部高压电烧伤创面并行旁路静脉桥接的效果。1A.入院时,头部创面情况；1B.入院后30 d,去除裸露颅骨表层骨质并应用磨钻浅层钻孔后创面情况；1C.术中设计的股前外侧分叶皮瓣；1D.术中切取的股前外侧皮瓣；1E.术中切取的10 cm长的大隐静脉；1F.皮瓣修复术后即刻,左侧颞部切口为动脉及一伴行静脉吻合区,左侧颈部切口为另一伴行静脉吻合区；1G.将大腿供区创面直接拉拢缝合后即刻；1H.伤后3个月,头部创面愈合情况

下载: 全尺寸图片幻灯片