用下肢毁损性创面患者截肢后废弃肢体制成的组织瓣的临床应用效果

黄覛韬; 何志友; 张丕红; 张明华; 崔旭; 郭乐; 黄晓元; 梁鹏飞

doi:10.3760/cma.j.cn501225-20240605-00212

用下肢毁损性创面患者截肢后废弃肢体制成的组织瓣的临床应用效果

doi: 10.3760/cma.j.cn501225-20240605-00212

中南大学湘雅医院烧伤整形外科,长沙　　410008

基金项目:

湖南省自然科学青年基金项目 2022JJ40791

详细信息

通讯作者:
梁鹏飞,Email：liangpengfeijbm@163.com

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出版历程
- 收稿日期: 2024-06-05

Clinical application effects of tissue flaps prepared from the discarded limbs after amputation in patients with destructive wounds in the lower limbs

Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China

Funds:

Youth Fund Program of Hunan Provincial Natural Science Foundation of China 2022JJ40791

More Information

Corresponding author: Liang Pengfei, Email: liangpengfeijbm@163.com

摘要

摘要: 目的探讨用下肢毁损性创面患者截肢后废弃肢体制成的组织瓣的临床应用效果。方法该研究为回顾性观察性研究。2019年3月—2024年3月,中南大学湘雅医院烧伤整形外科收治7例符合入选标准的下肢毁损性创面男性患者,年龄35~57岁。毁损肢体经临床处理后仍难以保肢,采用截肢后废弃肢体制成的组织瓣带蒂移植修复下肢毁损性创面者5例,其中创面面积为15 cm×10 cm~25 cm×15 cm,组织瓣切取面积为15 cm×10 cm~20 cm×15 cm；采用截肢后废弃肢体制成的组织瓣游离移植修复下肢毁损性创面者2例,其中创面面积为22 cm×18 cm、25 cm×15 cm,组织瓣切取面积为23 cm×20 cm、25 cm×18 cm。随访观察组织瓣存活情况、受区创面愈合情况和外观。末次随访时,采用皮瓣综合评价量表评定受区恢复情况,并记录佩戴矫正假肢情况。结果随访6~24个月,组织瓣均存活,受区创面愈合较佳且外观良好。末次随访时,受区恢复情况评分为36~39分（平均37.2分）,截肢肢体均可佩戴矫正假肢且远端无破溃。结论利用下肢毁损性创面患者截肢后废弃肢体制成的组织瓣修复创面有效利用了废弃组织,避免产生新的供区,是修复多处毁损性创面的一种可供考虑的方法。
- 烧伤 /
- 四肢 /
- 外科皮瓣 /
- 截肢术 /
- 下肢毁损伤 /
- 废弃肢体 /
- 创面修复
Abstract: Objective To explore the clinical application effects of tissue flaps prepared from the discarded limbs after amputation in patients with destructive wounds in the lower limbs. Methods The study was a retrospective observational study. From March 2019 to March 2024, 7 male patients with destructive wounds in the lower limbs who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of Xiangya Hospital of Central South University, aged 35 to 57 years. After clinical treatment, the damaged limbs were still difficult to preserve. Five patients with destructive wounds in the lower limbs were repaired with pedicled tissue flaps prepared from the discarded limbs after amputation, with wound areas of 15 cm×10 cm to 25 cm×15 cm and tissue flap incision areas of 15 cm×10 cm to 20 cm×15 cm. Two patients with destructive wounds in the lower limbs were repaired with free tissue flaps prepared from the discarded limbs after amputation, with wound areas of 22 cm×18 cm and 25 cm×15 cm and tissue flap incision areas of 23 cm×20 cm and 25 cm×18 cm. The survival of the tissue flap, the healing and appearance of wounds in the recipient site were followed up. At the last follow-up, the recovery status of the recipient site was evaluated according to the comprehensive flap evaluation scale, and the status of corrective prosthesis fitting was recorded. Results During the follow-up of 6 to 24 months, all the tissue flaps successfully survived, with good healing and appearance of wounds in the recipient site. At the last follow-up, the scores of the recovery status of the recipient site ranged from 36 to 39 (with an average of 37.2). All amputated limbs were able to accommodate corrective prostheses with no distal ulceration. Conclusions Utilizing tissue flaps prepared from the discarded limbs after amputation in patients with destructive wounds in the lower limbs to repair wounds effectively uses the discarded tissue and avoid creating new donor sites, which is a method to be considered for repairing multiple destructive wounds.
- Burns /
- Extremities /
- Surgical flaps /
- Amputation /
- Destructive injuries in the lower limbs /
- Discarded limbs /
- Wound repair
黄覛韬：酝酿和设计研究,实施手术,采集、分析/解释数据,撰写文章,获取研究经费；何志友：实施手术,采集、分析/解释数据,对文章的知识性内容作批评性审阅；张丕红：酝酿和设计研究,实施手术,对文章的知识性内容作批评性审阅；张明华、崔旭、郭乐：实施手术,采集数据；黄晓元：指导手术；梁鹏飞：酝酿和设计研究,指导手术,分析/解释数据,对文章的知识性内容作批评性审阅

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图 1 采用左下肢截肢后废弃肢体制成的组织瓣修复例1患者右下肢毁损性创面的效果。1A.入院时,左下肢自左膝下方至左足远端可见大面积毁损；1B.入院时,右踝外侧及右足跟部可见大面积毁损；1C.左下肢清创后可见骨坏死及大量软组织坏死；1D.右下肢清创后可见踝关节肌腱及跖骨外露；1E.术中左下肢废弃肢体制成的游离组织瓣断蒂前；1F.术中游离组织瓣断蒂后,携带胫前、胫后血管；1G.术后1个月,右下肢组织瓣存活良好；1H.术后6个月,右下肢组织瓣存活良好、外观良好；1I.术后6个月,左下肢可正常佩戴矫正假肢,右下肢穿鞋后功能良好

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图 2 采用右下肢截肢后废弃肢体制成的组织瓣修复例2患者右下肢毁损性创面的效果。2A.入院时,双侧下肢可见大面积毁损；2B.双侧下肢清创+右下肢骨折外固定术后；2C.右下肢清创后可见右大腿下段以远毁损严重；2D.右下肢截肢前,保留胫前血管及残余皮肤软组织；2E.术中右下肢截肢后肢体近端创面缺损大,并根据右下肢截肢后肢体近端创面大小设计右下肢废弃肢体制成的带蒂组织瓣；2F.术中将组织瓣翻转覆盖于创面后即刻；2G.术后2个月,右下肢组织瓣存活良好；2H.术后2个月,左下肢（正面观）恢复可；2I.术后6个月,双侧下肢（背面观）恢复可

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