顺行股前外侧带蒂皮瓣修复会阴部或腹股沟区创面的临床效果

王韶华; 王顺宾; 许钊荣; 陈昭宏

doi:10.3760/cma.j.cn501225-20240218-00064

顺行股前外侧带蒂皮瓣修复会阴部或腹股沟区创面的临床效果

doi: 10.3760/cma.j.cn501225-20240218-00064

福建医科大学附属协和医院烧伤与创面修复科,福建省烧伤研究所,福建省烧伤医学中心,福建省烧创伤重点实验室,福州　　350001

基金项目:

福建省医疗“创双高”建设经费 202176

福建省卫生计生青年科研课题资助计划 2017-1-44

详细信息

通讯作者:
许钊荣,Email：234828306@qq.com

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出版历程
- 收稿日期: 2024-02-18
- 网络出版日期: 2024-10-10

Clinical effects of antegrade anterolateral thigh pedicled perforator flaps in repairing wounds in the perineum or inguinal regions

Department of Burns and Wound Repair, Union Hospital, Fujian Medical University, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Provincial Key Laboratory of Burn and Trauma, Fuzhou 350001, China

Funds:

The Construction Program of Medical "Double High" in Fujian Province of China 202176

Fujian Provincial Health and Family Planning Youth Scientific Research Project Funding Program 2017-1-44

More Information

Corresponding author: Xu Zhaorong, Email: 234828306@qq.com

摘要

摘要: 目的探讨采用顺行股前外侧带蒂皮瓣修复会阴部或腹股沟区创面的临床效果。方法该研究为回顾性观察性研究。2022年1月—2024年5月,福建医科大学附属协和医院收治7例符合入选标准的会阴部或腹股沟区创面患者,其中男5例、女2例,年龄54~72岁。清创后创面面积为8 cm×6 cm~16 cm×11 cm。术中切取面积为9 cm×7 cm~18 cm×13 cm的顺行股前外侧带蒂皮瓣转移修复创面。将皮瓣供区创面直接缝合或移植大腿刃厚皮片修复。术后观察皮瓣成活情况,皮瓣供区创面愈合及皮片成活情况。随访观察皮瓣质地、色泽、血运情况,根据Lovett肌力分级标准评估患侧下肢肌力,采用改良Ashworth量表评估患侧下肢肌张力,观察下肢运动恢复情况、创面有无复发和供区瘢痕形成情况。结果术后皮瓣均成活,皮瓣供区创面均愈合,皮片均成活。随访2~29个月,皮瓣质地柔软、色泽与周围正常皮肤组织相近、血运良好；患侧下肢肌力为4级者2例、5级者5例,肌张力均为0级,运动无异常；创面未复发,供区无明显瘢痕畸形。结论顺行股前外侧带蒂皮瓣移植是修复会阴部和腹股沟区创面的有效方式之一,手术操作简便,术后供受区外观较好,患肢功能良好,值得临床推广。
- 显微外科手术 /
- 外科皮瓣 /
- 会阴 /
- 腹股沟 /
- 股前外侧皮瓣 /
- 创面修复
Abstract: Objective To explore the clinical effects of antegrade anterolateral thigh pedicled perforator flaps in repairing wounds in the perineum or inguinal regions. Methods The study was a retrospective observational study. From January 2022 to May 2024, 7 patients with wounds in the perineum or inguinal regions who met the inclusion criteria were admitted to Fujian Medical University Union Hospital, including 5 males and 2 females, aged 54 to 72 years. The wound area after debridement was 8 cm×6 cm to 16 cm×11 cm. During the operation, antegrade anterolateral thigh pedicled perforator flaps with area of 9 cm×7 cm to 18 cm×13 cm were harvested to repair the wounds. The wounds in the flap donor sites were sutured directly or repaired with split-thickness skin grafts from the thigh. The survival of flaps and the healing of wounds and the survival of skin grafts in flap donor sites were observed after operation. During follow-up, the texture, color, and blood supply of flaps were observed, the muscle strength of the affected lower extremity was evaluated according to Lovett muscle strength grading standard, the muscle tension of the affected lower extremity was evaluated by modified Ashworth scale, and the recovery of lower extremity movement, wound recurrence, and scar formation in the flap donor sites were observed. Results The flaps all survived successfully. All the wounds in the flap donor sites healed and the skin grafts all survived. During 2 to 29 months of follow-up, the flaps were soft in texture, similar in color to the surrounding normal skin tissue with good blood supply. The affected lower extremity was evaluated as grade 4 in 2 patients and grade 5 in 5 patients in muscle strength, with all grade 0 in muscle tension and no abnormal in movement. No wound recurred and no obvious scar deformity in the flap donor site was observed. Conclusions The antegrade anterolateral thigh perforator pedicled flap is one of the effective methods to repair wounds in the perineum and inguinal regions. The procedure is easy to operate, with good postoperative appearances of the donor and recipient sites and good function of affected limbs, which is worthy of clinical promotion.
- Microsurgery /
- Surgical flaps /
- Perineum /
- Groin /
- Anterolateral thigh flap /
- Wound repair
王韶华：设计研究,实施手术,采集、分析、解释数据,撰写文章；王顺宾：指导、实施手术,分析、解释数据,审阅文章；许钊荣：设计研究,实施手术,采集、分析、解释数据,修改、审阅文章；陈昭宏：设计研究,指导手术,获取研究经费

所有作者均声明不存在利益冲突

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参考文献(37)

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图 1 采用顺行股前外侧带蒂皮瓣修复例1患者腹股沟区坏死性筋膜炎创面的效果。1A.入院时腹股沟区可见皮肤软组织感染坏死创面；1B.术前创面情况；1C.术中清创后创面基底肉芽组织红润；1D.术中设计股前外侧带蒂皮瓣；1E.术中沿设计线切取皮瓣；1F.术中皮瓣切取完成；1G.术中皮瓣转移覆盖创面后即刻；1H.术区及皮瓣供区创面缝合后即刻；1I.术后6个月,右腹股沟区创面愈合良好,皮瓣供区遗留线性瘢痕

注：图中黄色箭头指示外露睾丸、绿色箭头指示旋股外侧动脉降支主干

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图 2 采用顺行股前外侧带蒂皮瓣转移修复例2患者腹股沟区放射性溃疡创面的效果。2A.术前腹股沟区创面可见基底有大量白色坏死组织,创缘组织活力差；2B.术中清创后可见创面基底红润、血运良好,设计股前外侧带蒂皮瓣；2C.术中皮瓣切取后即刻；2D.术中皮瓣血管蒂情况；2E.皮瓣供受区创面缝合后即刻；2F.术后5个月,右腹股沟区创面愈合良好,色泽与周围皮肤相近,皮瓣供区可见线性瘢痕

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图 3 采用顺行股前外侧带蒂皮瓣转移修复例3乳房外佩吉特病（会阴部）患者扩大切除术后创面的效果。3A.术前乳房外佩吉特病（会阴部）病变部位可见块状隆起,颜色淡红,分泌少量液体；3B.术中扩大切除肿物；3C.术中设计股前外侧带蒂皮瓣；3D.术中皮瓣切取完成；3E.术中皮瓣覆盖创面后即刻（黄色箭头指示残余阴囊皮肤形成的阴囊皮瓣覆盖裸露的阴茎和睾丸）；3F.术后2周拆线即刻,皮瓣愈合良好,色泽与周围正常皮肤组织相近

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