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Volume 38 Issue 4
Apr.  2022
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2022  >  38(4): 321-327
Chen L,Zhang W,Xie WG,et al.Clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture deformity after extensive burns[J].Chin J Burns Wounds,2022,38(4):321-327.DOI: 10.3760/cma.j.cn501225-20220210-00021.
Citation: Chen L,Zhang W,Xie WG,et al.Clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture deformity after extensive burns[J].Chin J Burns Wounds,2022,38(4):321-327.DOI: 10.3760/cma.j.cn501225-20220210-00021.
shu

Clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture deformity after extensive burns

doi: 10.3760/cma.j.cn501225-20220210-00021

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

Funds:

Scientific Research Project of Health Commission of Hubei Province of China WJ2019H433

Clinical Medical Research Project of Wuhan WX17A03, WX11A04

Medical Research Project of Wuhan WG19B02

More Information
  • Corresponding author: Zhang Wei, Email: zhw010@163.com
  • Received Date: 2022-02-10
    Abstract
  •   Objective  To investigate the clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture after extensive burns.  Methods  A retrospective observational study was conducted. From August 2017 to October 2021, 7 patients with severe scar contracture deformity caused by extensive burns were hospitalized in Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, including 5 males and 2 females, aged 26-65 years, with scar area of 20 cm×4 cm-34 cm×14 cm. In the first stage, the rectangular skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 500-600 mL were embedded above the inguinal ligament, and then normal saline was injected after stitch removal for expansion to meet the needs of repair surgery. In the second stage, the scar was removed by surgical excision to correct the deformity and release the adhesion and contracture; after the removal of the expanders, the expanded ilioinguinal free flaps were harvested. When a larger flap was needed, the paraumbilical perforator flap was harvested at the same time, and the flaps were transplanted to the secondary wound after scar resection. The number of embedded expanders, the total amount of injected normal saline, the expansion time, the complications of skin and soft tissue expansion, the number, area, thickness, and anastomotic vascular pedicles of the expanded ilioinguinal flaps being resected, the type of flaps used, the repair method of flap donor sites, and the survival of flaps after operation were observed and recorded. The long-term repair effect and donor site condition were followed up. At the last follow-up, the patients' satisfaction with the curative effect of each surgical site was investigated according to the grade 5 score of Likert scale.  Results  A total of 10 expanders were embedded in 7 patients, of which 4 patients had 1 each and 3 patients had 2 each. The total volume of normal saline injected was 800-1 800 (1 342±385) mL, and the expansion time was 4-24 (11±5) months. One patient had the expander exposed due to infection after the expander being inserted, while the other patients had no complications of skin and soft tissue expansion. Totally 10 expanded ilioinguinal flaps with the area of 22 cm×6 cm-36 cm×16 cm ((326±132) cm2) and the thickness of 0.6-1.1 (0.77±0.16) cm were harvested. Among the 10 expanded ilioinguinal flaps, 5 were pedicled with the superficial circumflex iliac artery, 3 with the superficial abdominal artery with relatively large caliber, 1 with the common trunk of the superficial circumflex iliac artery and the superficial abdominal artery, and 1 flap was anastomosed with the superficial circumflex iliac artery and bridged the superficial abdominal artery for intra-arterial supercharge. Unilateral expanded ilioinguinal flap combined with ipsilateral paraumbilical perforator flap were harvested in 4 cases, bilateral expanded ilioinguinal flaps were harvested in 1 case, and unilateral expanded ilioinguinal flap was harvested in 2 cases. Except for 1 case being transplanted with autologous split-thickness scalp to repair the flap donor site after combined resection of bilateral expanded ilioinguinal flaps, the donor sites of the other patients were sutured directly. All the flaps survived after operation without tip necrosis or wound residue. Follow-up for 3-30 (15±10) months showed that the flap was soft and not bloated, the function and appearance of the recipient area were significantly improved compared with those before operation, and the appearance of the donor sites was good. At the last follow-up, the patients' satisfaction with the treatment effect of the surgical site scored 4-5 (4.5±0.4).  Conclusions  The expanded ilioinguinal flap can be obtained in a large area. It has the advantages of rich blood supply, less damage to the donor site, concealed location, and being convenient to be resected and transplanted in combination with the paraumbilical perforator flap. It is suitable for the clinical reconstruction and treatment of severe scar contracture deformity after extensive burns.

     

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    • References(31)
  • [1]
    彭君强,李养群,赵穆欣,等.皮肤软组织扩张术修复四肢大面积瘢痕的效果[J].中华烧伤杂志,2019,35(4):308-310.DOI: 10.3760/cma.j.issn.1009-2587.2019.04.011.
    [2]
    沈余明.深度烧伤后瘢痕增生挛缩畸形的手术治疗[J].中华烧伤杂志,2019,35(6):401-404.DOI: 10.3760/cma.j.issn.1009-2587.2019.06.001.
    [3]
    OgawaR. Surgery for scar revision and reduction: from primary closure to flap surgery[J/OL]. Burns Trauma,2019,7:7 [2022-02-10].https://pubmed.keketh.cn/30891462/.DOI: 10. 1186/s41038-019-0144-5.
    [4]
    马显杰, 丁健科. 皮肤软组织扩张术在儿童体表病损修复中的应用[J]. 中华烧伤与创面修复杂志,2022, 38(4): 301-305. DOI: 10.3760/cma.j.cn501120-20211019-00359.
    [5]
    胡骁骅,覃凤均,李娟,等.穿支皮瓣整复严重烧伤患者四肢大关节部位瘢痕增生挛缩畸形的效果[J].中华烧伤杂志,2019,35(6):417-422.DOI: 10.3760/cma.j.issn.1009-2587.2019.06.004.
    [6]
    夏成德,薛继东,狄海萍,等.额顶部跨中线轴型扩张皮瓣单蒂转移整复面颈部大面积瘢痕畸形的临床效果[J].中华烧伤杂志,2020,36(9):838-844.DOI: 10.3760/cma.j.cn501120-20200311-00149.
    [7]
    PukancsikD,KelemenP,GulyásG,et al.Clinical experiences with the use of ULTRAPRO® mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: a retrospective cohort study[J].Eur J Surg Oncol,2017,43(7):1244-1251.DOI: 10.1016/j.ejso.2017.01.236.
    [8]
    McGregorIA,JacksonIT.The groin flap[J].Br J Plast Surg,1972,25(1):3-16.DOI: 10.1016/s0007-1226(72)80003-1.
    [9]
    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,C1-C3.DOI: 10.3760/cma.j.cn441206-20200213-00054.
    [10]
    GohTLH,ParkSW,ChoJY,et al.The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap--a review of 210 cases[J].Plast Reconstr Surg,2015,135(2):592-601.DOI: 10.1097/PRS.0000000000000951.
    [11]
    HongJP,SunSH,Ben-NakhiM.Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects[J].Ann Plast Surg,2013,71(4):380-383.DOI: 10.1097/SAP.0b013e3182503ac5.
    [12]
    中国整形美容协会瘢痕医学分会.瘢痕早期治疗全国专家共识(2020版)[J].中华烧伤杂志,2021,37(2):113-125.DOI: 10.3760/cma.j.cn501120-20200609-00300.
    [13]
    马显杰,李威扬,刘超华,等.面部烧伤后瘢痕的美学整复策略及疗效[J].中华烧伤杂志,2016,32(8):469-473.DOI: 10.3760/cma.j.issn.1009-2587.2016.08.006.
    [14]
    张伟,谢卫国,张卫东,等.吻合血管的扩张皮瓣治疗大面积烧伤患者瘢痕挛缩畸形[J].中华烧伤杂志,2019,35(6):410-416.DOI: 10.3760/cma.j.issn.1009-2587.2019.06.003.
    [15]
    杜伟力,沈余明,胡骁骅,等.供瓣区美学修复方法的探讨[J].中华烧伤杂志,2020,36(2):97-105.DOI: 10.3760/cma.j.issn.1009-2587.2020.02.004.
    [16]
    HocaoğluE,EmeklıU,ÇızmecıO,et al.Suprafascial pre-expansion of perforator flaps and the effect of pre-expansion on perforator artery diameter[J].Microsurgery,2014,34(3):188-196.DOI: 10.1002/micr.22184.
    [17]
    WangC,YangS,PuLL.Pre-expanded super-thin skin perforator flaps[J].Clin Plast Surg,2017,44(1):31-40.DOI: 10.1016/j.cps.2016.08.008.
    [18]
    AtikB,TanO,CeylanK,et al.Reconstruction of wide scrotal defect using superthin groin flap[J].Urology,2006,68(2):419-422.DOI: 10.1016/j.urology.2006.04.003.
    [19]
    孙广峰,魏在荣,金文虎,等.扩张髂腹股沟超薄皮瓣修复手部前臂瘢痕[J].中华手外科杂志,2015,31(1):53-55.DOI: 10.3760/cma.j.issn.1005-054X.2015.01.020.
    [20]
    郑捷新,张勤,刘琰,等.大面积烧伤瘢痕的后期整复治疗[J].上海交通大学学报(医学版),2010,30(5):600-603.
    [21]
    孙广峰,聂开瑜,邓呈亮,等.游离旋髂浅动脉穿支皮瓣修复足踝部皮肤软组织缺损[J].中国修复重建外科杂志,2016,30(11):1396-1399.DOI: 10.7507/1002-1892.20160287.
    [22]
    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.
    [23]
    贾颖,王铁铮,刘林峰,等.旋髂浅动脉皮瓣血管的解剖与超声评价[J].医学影像学杂志,2020,30(3):486-488.
    [24]
    KashiwaK,KobayashiS,SaitoA,et al.Inferior extension of the groin flap based on the descending branch of the superficial circumflex iliac artery[J].J Reconstr Microsurg,2002,18(8):653-658.DOI: 10.1055/s-2002-36495.
    [25]
    SinnaR,HajjiH,QassemyarQ,et al.Anatomical background of the perforator flap based on the deep branch of the superficial circumflex iliac artery (SCIP flap): a cadaveric study[J].Eplasty,2010,10:e11.
    [26]
    寇伟,胡勇,朱磊,等.游离髂腹股沟皮瓣在手足创面修复中的应用[J].中华显微外科杂志,2013,36(4):400-402.DOI: 10.3760/cma.j.issn.1001-2036.2013.06.032.
    [27]
    王晓敏,马士崟,张凯,等.腹壁浅动脉皮瓣的应用解剖及其在头颈部修复中的意义[J].中国临床解剖学杂志,2011,29(4):378-381.
    [28]
    韩军涛,谢松涛,陶克,等.旋髂浅动脉岛状分叶皮瓣修复下腹部及会阴区瘢痕挛缩22例[J].中华烧伤杂志,2012,28(2):153-154.DOI: 10.3760/cma.j.issn.1009-2587.2012.02.022.
    [29]
    喜雯婧,冯少清,李华,等.旋髂浅动脉穿支皮瓣的重新评价和手术策略[J].中华显微外科杂志,2018,41(4):313-318.DOI: 10.3760/cma.j.issn.1001-2036.2018.04.001.
    [30]
    李广学,穆籣,杨锴,等.吲哚菁绿血管造影在腹部皮瓣乳房再造中的应用[J].中华整形外科杂志,2018,34(7):522-525.DOI: 10.3760/cma.j.issn.1009-4598.2018.07.007.
    [31]
    KhoongYM,HuangX,GuS,et al.Imaging for thinned perforator flap harvest: current status and future perspectives[J/OL].Burns Trauma,2021,9:tkab042[2022-02-10].https://pubmed.ncbi.nlm.nih.gov/34926708/.DOI: 10.1093/burnst/tkab042.
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