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Volume 39 Issue 8
Aug.  2023
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(8): 758-764
Li H,Xiao SE,Deng CL,et al.Clinical application of combination of different types of free perforator flaps in the repair of complex wounds in extremities[J].Chin J Burns Wounds,2023,39(8):758-764.DOI: 10.3760/cma.j.cn501225-20220720-00300.
Citation: Li H,Xiao SE,Deng CL,et al.Clinical application of combination of different types of free perforator flaps in the repair of complex wounds in extremities[J].Chin J Burns Wounds,2023,39(8):758-764.DOI: 10.3760/cma.j.cn501225-20220720-00300.
shu

Clinical application of combination of different types of free perforator flaps in the repair of complex wounds in extremities

doi: 10.3760/cma.j.cn501225-20220720-00300

  • Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, the Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi 563003, China

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Collaborative Innovation Center of Chinese Ministry of Education 2020-39

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    Abstract
  •   Objective   To investigate the clinical application effects of combination of different types of free perforator flaps in the repair of complex wounds in extremities.   Methods   A retrospective observational study was conducted. From January 2018 to June 2022, 11 patients with complex wounds in extremities who met the inclusion criteria was admitted to the Affiliated Hospital of Zunyi Medical University, including 8 males and 3 females, aged 28 to 55 years. The wounds in the upper extremities in 4 cases and in the lower extremities in 7 cases were repaired with different combination of free perforator flaps. After debridement, the wound area was 7.0 cm×6.0 cm-28.0 cm×12.0 cm. A combination of different types of perforator flaps were applied, including the perforator tri-leaf flap of the descending branch of the lateral femoral circumflex artery in 6 cases, the descending branch of lateral femoral circumflex artery combined with oblique branch perforating branch flap in 2 cases, the lobulated flap of the descending branch of the lateral femoral circumflex artery combined with the contralateral medial plantar artery perforator flap in 2 cases, and the bilateral perforator flap of the descending branch of lateral femoral circumflex artery combined with great toe nail flap in 1 case, with the size of a single flap ranged from 2.0 cm×2.0 cm-25.0 cm×6.0 cm. The donor site was repaired by direct suture, skin grafting, or flap transplantation. During free flap transplantation, the flap was cut and split according to the distribution of perforators, and end-to-end or end-to-side anastomosis was performed between the donor area and the recipient area. After surgery, the survival of transplanted flap in the primary recipient site, the occurrence of vascular crisis, the wound healing in the flap donor site, and the survival of transplanted skin or flap in the flap donor site were observed. During follow-up, the blood supply, appearance and texture of the transplanted flap in the primary recipient site were observed; and at the same time, the weight bearing of the plantar receiving area, the presence of sliding, ulcers, and sinus tracts of the flap, and the appearance and function of the hand were observed; the complications in the donor area were observed.   Results   After surgery, one patient's transplanted flap in the primary recipient site had vascular crisis but survived after exploration+vein graft bridging; partial necrosis occurred in one lobe of anterolateral thigh lobulated flap transplanted to the primary recipient site in one patient and recovered after dressing change+skin grafting, and the different types of perforator flap transplanted to the primary recipient site in the other 9 patients all survived. After surgery, the wound with direct suture at the donor site healed well, and the skin or flap transplanted to the donor area survived well. During 3-24 months of follow-up, the blood supply, appearance, and texture of the transplanted flap at the primary recipient site were good. In two patients, the anterolateral thigh flap combined with the medial plantar flap were used to repair plantar defects. The plantar receiving area was able to bear weight, and the texture of the flaps in the recipient area was close to the normal plantar skin, without flap sliding, ulcer, or sinus tract formation. In one patient, bilateral anterolateral thigh flap combined with great toe nail flap were used to repair hand combined with soft forearm defect, and the appearance and function of hand, especially thumb were good. Only linear scar was left in the donor site without other obvious complications.   Conclusions   The combination of different types of perforator flaps is a reliable clinical method to repair complex wounds in extremities with high safety, good efficacy, and less complications.

     

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    • References(30)
  • [1]
    李海, 肖顺娥, 邓呈亮, 等. 游离分叶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(1):98-101. DOI: 10.7507/1002-1892.202108084.
    [2]
    田敏涛, 李苗钟, 胡浩良, 等. 不同动脉吻合方式的游离旋髂浅动脉穿支皮瓣移植修复四肢皮肤软组织缺损[J].中华创伤杂志,2022,38(2):149-154. DOI: 10.3760/cma.j.cn501098-20210922-00508.
    [3]
    柳志锦, 巨积辉, 刘胜哲, 等. 多种类型混合型供血的双叶股前外侧穿支皮瓣修复创面[J].中华手外科杂志,2021,37(2):125-128. DOI: 10.3760/cma.j.cn311653-20200226-00074.
    [4]
    郑和平. 特殊部位与特殊类型穿支皮瓣基础研究[J].中国临床解剖学杂志,2020,38(2):121-122. DOI: 10.13418/j.issn.1001-165x.2020.02.001.
    [5]
    唐举玉, 徐达传, 徐永清, 等. 特殊形式穿支皮瓣及其衍生术式命名专家共识[J].中华显微外科杂志,2022,45(1):5-13. DOI: 10.3760/cma.j.cn441206-20220114-00010.
    [6]
    ZhangYX, HayakawaTJ, LevinLS, et al. The economy in autologous tissue transfer: part 1. The kiss flap technique[J]. Plast Reconstr Surg, 2016,137(3):1018-1030. DOI: 10.1097/01.prs.0000479971.99309.21.
    [7]
    胡涛涛, 常树森, 魏在荣, 等. 改良三纵五横法在股前外侧穿支皮瓣修复术前穿支定位中的应用研究[J].中国修复重建外科杂志,2021,35(8):1027-1032. DOI: 10.7507/1002-1892.202103074.
    [8]
    李海, 魏在荣, 张文夺, 等. 多穿支旋股外侧动脉穿支皮瓣在儿童四肢复杂创面中的应用[J].中华显微外科杂志,2017,40(5):428-432. DOI: 10.3760/cma.j.issn.1001-2036.2017.05.004.
    [9]
    张世民. 皮瓣远侧血液循环增强技术:外增压、内增压和超回流[J].中华显微外科杂志,2016,39(6):524-525. DOI: 10.3760/cma.j.issn.1001-2036.2016.06.002.
    [10]
    巨积辉, 周荣, 刘跃飞, 等. 超长股外侧区内增压型穿支皮瓣修复足踝部创面的临床效果[J].中华烧伤杂志,2019,35(7):495-500. DOI: 10.3760/cma.j.issn.1009-2587.2019.07.004.
    [11]
    金文虎, 张子阳, 吴祥奎, 等. 旋股外侧动脉嵌合皮瓣在足踝部复杂创面中的应用[J].中国修复重建外科杂志,2021,35(7):891-895. DOI: 10.7507/1002-1892.202102039.
    [12]
    宋达疆, 李赞, 章一新, 等. 联体双侧血管蒂腹壁下动脉穿支皮瓣行乳房重建[J].中华显微外科杂志,2020,43(5):441-445. DOI: 10.3760/cma.j.cn441206-20200225-00097.
    [13]
    朱雄翔, 郑朝, 张冬梅, 等. 扩张穿支皮瓣游离移植治疗儿童严重瘢痕挛缩畸形的效果[J].中华烧伤杂志,2019,35(6):405-409. DOI: 10.3760/cma.j.issn.1009-2587.2019.06.002.
    [14]
    唐举玉. 特殊形式穿支皮瓣系列教程(一)——血流桥接穿支皮瓣[J].中华显微外科杂志,2022,45(4):476-480. DOI: 10.3760/cma.j.cn441206-20220629-00134.
    [15]
    HallockGG.Simplified nomenclature for compound flaps[J].Plast Reconstr Surg,2000,105:1465-1470. DOI: 10.1097/00006534-200004000-00031.
    [16]
    KoshimaI.A new classification of free combined or connected tissue transfers:introduction to the concept of bridge,siamese,chimeric,mosaic,and chain-circle flaps[J].Acta Med Okayama,2001,55(6):329-332.
    [17]
    唐举玉, 贺继强, 吴攀峰, 等. 股前外侧分叶-嵌合穿支皮瓣在四肢复杂创伤修复中的应用[J].中华显微外科杂志,2020,43(4):326-330. DOI: 10.3760/cma.j.cn441206-20190309-00089.
    [18]
    何嘉乐,路云翔,陈郁鲜,等. 改良带血管蒂髂骨瓣修复股骨近端病损的疗效观察[J]. 中华显微外科杂志,2023,46(1):108-113. DOI: 10.3760/cma.j.cn441206-20221107-00227.
    [19]
    印飞, 王军, 沈小芳, 等. 不携带一级源血管的游离股前外侧穿支皮瓣修复儿童手背创面[J].中国修复重建外科杂志,2019,33(12):1593-1594. DOI: 10.7507/1002-1892.201903038.
    [20]
    杨林,曹阳,程俊楠,等. 以旋股外侧动脉斜支为蒂股前外侧皮瓣的穿支分布特点与临床应用[J]. 中华整形外科杂志,2023,39(5):463-471.DOI: 10.3760/cma.j.cn114453-20230213-00031.
    [21]
    常树森, 魏在荣, 金文虎, 等. 股前外侧皮瓣三纵五横法设计方案的临床研究[J].中华整形外科杂志,2019,35(6):571-576. DOI: 10.3760/cma.j.issn.1009-4598.2019.06.011.
    [22]
    裴广楠, 李甲, 滕道练, 等. 游离足底内侧皮瓣修复手指侧方狭长创面13例[J].中华显微外科杂志,2022,45(6):669-672. DOI: 10.3760/cma.j.cn441206-20211119-00279.
    [23]
    杨学林, 刘春, 胡福兴, 等. 含神经的游离足底内侧皮瓣修复小儿足跟软组织缺损[J].中华整形外科杂志,2021,37(11):1251-1255. DOI: 10.3760/cma.j.cn114453-20200127-00021.
    [24]
    李木卫, 马立峰, 王洪刚, 等. 吻合血管的𧿹趾断层甲床皮瓣移植修复手指甲床及软组织缺损[J].中华显微外科杂志,2019,42(1):5-8. DOI: 10.3760/cma.j.issn.1001-2036.2019.01.003.
    [25]
    喻田, 阮奕焕, 王亚军, 等. 吻合趾背动脉的𧿹甲瓣修复拇指甲床及背侧皮肤软组织缺损[J].实用手外科杂志,2022,36(2):197-199. DOI: 10.3969/j.issn.1671-2722.2022.02.020.
    [26]
    李文涛, 丁桂友, 王斌, 等. 足底内侧皮瓣串联股前外侧皮瓣修复前足负重区及周围软组织缺损[J].临床骨科杂志,2023,26(1):126. DOI: 10.3969/j.issn.1008-0287.2023.01.041.
    [27]
    彭城, 黎蕊, 黄东旭, 等. 游离皮瓣坏死的危险因素:多变量Logistic回归分析[J].中华显微外科杂志,2017,40(4):337-341. DOI: 10.3760/cma.j.issn.1001-2036.2017.04.007.
    [28]
    丁艳妮, 宋达疆, 李赞, 等. 游离皮瓣移植乳房再造手术并发血管危象的原因以及分类和分期特点探讨[J].中国美容整形外科杂志,2023,34(2):85-89,104. DOI: 10.3969/j.issn.1673-7040.2023.02.007.
    [29]
    胡蓉, 何翠环, 周翔, 等. 血管吻合术后应用低分子右旋糖酐与皮肤瘙痒和血管危象相关性的临床观察[J].中华显微外科杂志,2022,45(4):457-459. DOI: 10.3760/cma.j.cn441206-20220328-00061.
    [30]
    魏在荣, 汪华侨, 王达利, 等. 穿支皮瓣供瓣区选择原则[J].中华显微外科杂志,2016,39(5):417-419. DOI: 10.3760/cma.j.issn.1001-2036.2016.05.001.
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