嵌合穿支皮瓣修复骨或内固定外露创面及骨髓炎创面的临床效果

程琳; 刘先奇; 杜伟力; 代强; 车可心; 沈余明

doi:10.3760/cma.j.cn501225-20231120-00198

嵌合穿支皮瓣修复骨或内固定外露创面及骨髓炎创面的临床效果

doi: 10.3760/cma.j.cn501225-20231120-00198

1.
首都医科大学附属北京积水潭医院烧伤科,北京　　100035
2.
烟台业达医院烧伤整形科,烟台　　265500

基金项目:

北京积水潭医院人才培养“学科新星”计划 XKXX2022003

详细信息

通讯作者:
沈余明,Email：shenyuming1963@163.com

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出版历程
- 收稿日期: 2023-11-20

Clinical effects of chimeric perforator flaps in repairing wounds with bone or internal fixation exposure and wounds with osteomyelitis

1.
Department of Burns, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
2.
Department of Burns and Plastics, Yantai Yeda Hospital, Yantai 265500, China

Funds:

Talent Cultivation Plan of Notable Emerging Talent in Beijing Jishuitan Hospital XKXX2022003

More Information

Corresponding author: Shen Yuming, Email: shenyuming1963@163.com

摘要

摘要: 目的探讨应用嵌合穿支皮瓣修复骨或内固定外露创面及骨髓炎创面的临床效果。方法该研究为回顾性观察性研究。2018年1月—2022年12月,首都医科大学附属北京积水潭医院收治20例符合入选标准的骨或内固定外露创面及骨髓炎创面患者,其中男19例、女1例,年龄21~73岁。共21个创面,包括5个骨外露创面、12个骨髓炎创面、4个内固定外露创面。Ⅰ期清创后创面面积为6 cm×3 cm~22 cm×10 cm,之后行负压封闭引流5~7 d。Ⅱ期采用带蒂腓肠内侧动脉嵌合穿支皮瓣、带蒂胫后动脉嵌合穿支皮瓣、游离旋股外侧动脉降支嵌合穿支皮瓣、游离腓肠内侧动脉嵌合穿支皮瓣、游离旋髂深动脉嵌合穿支皮瓣覆盖创面（皮瓣切取面积为7 cm×5 cm~25 cm×12 cm）,嵌合的肌瓣填充深部不规则腔隙。将皮瓣供区创面直接缝合或移植大腿中厚皮修复。观察术后皮瓣的成活情况、皮瓣供区创面愈合情况,随访感染有无复发。结果 18个游离嵌合穿支皮瓣中,16个皮瓣顺利成活；1个皮瓣术后当天发生静脉危象,经急诊探查重新吻合后,最终成活；1个皮瓣远端部分坏死,经换药后愈合。皮瓣供区创面均顺利愈合。3个带蒂嵌合穿支皮瓣均成活,其中1个出现皮瓣下感染,经清创+放置骨水泥后愈合。1个皮瓣供区切口裂开,经再次清创缝合后愈合；另2个皮瓣供区创面愈合良好。随访3~12个月,骨外露、内固定外露创面患者未出现异常渗出或感染表现,骨髓炎创面患者感染未复发。结论对于骨或内固定外露创面及骨髓炎创面,采用嵌合穿支皮瓣修复能够有效覆盖创面、填充无效腔并控制感染,且对供区的损伤较小。
- 穿支皮瓣 /
- 骨髓炎 /
- 游离组织瓣 /
- 嵌合穿支皮瓣 /
- 创面修复
Abstract: Objective To explore the clinical effects of chimeric perforator flaps in repairing wounds with bone or internal fixation exposure and wounds with osteomyelitis. Methods This study was a retrospective observational study. From January 2018 to December 2022, 20 patients with wounds with bone or internal fixation exposure and wounds with osteomyelitis who met the inclusion criteria were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University, including 19 males and 1 female, aged from 21 to 73 years. Among the 21 wounds, there were 5 wounds with bone exposure, 12 wounds with osteomyelitis, and 4 wounds with internal fixation exposure. After the debridement in the first stage, the wound area was 6 cm×3 cm to 22 cm×10 cm. Then vacuum sealing drainage was carried out for 5 to 7 days. In the second stage, the wounds were covered with pedicled chimeric medial sural artery perforator flap, pedicled chimeric posterior tibialis artery perforator flap, free chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery, free chimeric medial sural artery perforator flap or free chimeric deep circumflex iliac artery perforator flap with incision area of 7 cm×5 cm to 25 cm×12 cm. The chimeric muscle flap was used to fill and cover irregular deep cavities. The wounds in the flap donor sites were sutured directly or repaired with medium-thickness skin grafts from the thigh. The survival of flap and the healing of wound in flap donor site were observed after operation. The recurrence of infection was followed up. Results Among the 18 free chimeric perforator flaps, 16 flaps survived successfully; one flap experienced a venous crisis on the day of surgery and survived completely after emergency exploration and re-anastomosis; another one flap had partial distal necrosis, which healed after dressing changes. All the wounds in the flap donor sites healed evenly. All 3 pedicled chimeric perforator flaps survived; one of them developed sub-flap infection but healed after debridement and bone cement placement. The wound in the donor site of 1 flap developed incision dehiscence, which healed successfully after redebridement and suturing. The donor site wounds of the rest 2 flaps healed well. During 3 to 12 months of follow-up, the patients with wounds with bone or internal fixation exposure showed no signs of abnormal exudation or infection, and no infection recurrence was observed in patients with wounds with osteomyelitis. Conclusions The application of chimeric perforator flaps is effective in covering wounds, filling dead spaces, and controlling infection in wounds with bone or internal fixation exposure and wounds with osteomyelitis. Moreover, this method minimizes the damage to the donor site.
- Perforator flap /
- Osteomyelitis /
- Free tissue flaps /
- Chimeric flap /
- Wound repair
程琳：酝酿设计研究、论文撰写与修改、实施手术；刘先奇：论文修改、实施手术；杜伟力：研究指导、实施手术；代强、车可心：实施手术、采集与分析资料；沈余明：研究指导、论文修改、经费支持

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参考文献(35)

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下载: 全尺寸图片幻灯片

图 1 采用游离旋股外侧动脉降支嵌合穿支皮瓣修复例1患者胫骨外露创面的效果。1A.入院时,可见创面表面外用骨水泥；1B.Ⅰ期清创后可见胫骨外露及骨缺损；1C.Ⅱ期设计15 cm×7 cm的游离旋股外侧动脉降支嵌合穿支皮瓣；1D.Ⅱ期术中切取皮瓣；1E.采用皮瓣覆盖创面后即刻；1F.皮瓣供区创面直接缝合后即刻；1G、1H.分别为Ⅱ期术后1个月受区、供区创面,均愈合

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图 2 采用游离腓肠内侧动脉嵌合穿支皮瓣修复例2患者第1跖骨内固定外露及第2跖骨骨缺损创面的效果。2A.Ⅰ期清创,术中见表面皮肤缺损,内固定外露；2B.入院X线片显示第1跖骨骨折、第2跖骨骨折及骨缺损；2C.Ⅱ期设计7 cm×5 cm的游离腓肠内侧动脉嵌合穿支皮瓣；2D.Ⅱ期术中切取皮瓣；2E.采用皮瓣覆盖左足创面后即刻；2F.皮瓣供区创面直接缝合后即刻；2G、2H.分别为术后2周受区、供区创面,均愈合

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