基于彩色多普勒超声定位的分层削薄旋髂浅动脉穿支皮瓣的临床疗效

张文桐; 杨勇; 李峰; 李斌; 王丹丹; 陈涛; 李建峰

doi:10.3760/cma.j.cn501225-20240927-00358

基于彩色多普勒超声定位的分层削薄旋髂浅动脉穿支皮瓣的临床疗效

doi: 10.3760/cma.j.cn501225-20240927-00358

张文桐¹,
杨勇^2, ,,
李峰²,
李斌²,
王丹丹³,
陈涛³,
李建峰¹

1.
北京市顺义区医院手足外科,北京　　101300
2.
首都医科大学附属北京积水潭医院手外科,北京　　100035
3.
首都医科大学附属北京积水潭医院超声诊断科,北京　　100035

基金项目:

北京市卫生系统高层次卫生技术人才培养计划 2015-3-036

北京市医院管理中心“登峰”人才培养计划 DFL20240402

详细信息

通讯作者:
杨勇,Email：0414yang@sina.com

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出版历程
- 收稿日期: 2024-09-27

Clinical efficacy of layered thinning superficial circumflex iliac artery perforator flap based on color Doppler ultrasound positioning

1.
Department of Hand and Foot Surgery, Beijing Shunyi District Hospital, Beijing 101300, China
2.
Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
3.
Department of Ultrasound Diagnosis, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China

Funds:

Beijing Health System High-Level Health Technical Personnel Training Plan 2015-3-036

Beijing Hospital Management Center "Peak" Talent Training Plan DFL20240402

More Information

Corresponding author: Yang Yong, Email: 0414yang@sina.com

摘要

摘要: 目的探讨基于彩色多普勒超声（CDU）定位的分层削薄旋髂浅动脉穿支（SCIP）皮瓣的临床疗效。方法该研究为回顾性观察性研究。2023年2月—2024年2月,首都医科大学附属北京积水潭医院手外科收治符合入选标准的肢体创面患者14例,其中男11例、女3例,年龄15~60岁,创面面积为7 cm×4 cm~14 cm×11 cm。皮瓣移植术前应用CDU准确定位旋髂浅动脉浅支的深筋膜穿出点,术中分层削薄SCIP皮瓣,修复11例患者的手部、前臂创面和3例患者的足部创面,皮瓣切取面积为8 cm×5 cm~15 cm×12 cm。将皮瓣供区创面直接缝合。术中观察皮瓣供区内旋髂浅动脉浅支的深筋膜穿出点,并与术前CDU定位情况进行比对；测量皮瓣厚度。术后观察皮瓣成活情况及不良反应发生情况。随访时,观察皮瓣外观和质地、供区创面愈合情况。末次随访时,按照中华医学会手外科学会上肢部分功能评定试用标准对患肢腕、手功能进行评价,按照美国矫形足踝协会评分标准对患肢足踝功能进行评价。结果术中观察到所有皮瓣供区内旋髂浅动脉浅支的深筋膜穿出点与术前CDU定位一致,二者距离均<10 mm；皮瓣厚度为5~8 mm,平均6.2 mm。术后皮瓣均成活。随访5~12个月,所有皮瓣外观和质地良好；供区创面均愈合,仅遗留线性瘢痕。末次随访时,患肢腕、手功能评定为优者9例、良者1例、可者1例；患肢足踝功能评定为优者1例、良者2例。结论 CDU检查能够为分层削薄SCIP皮瓣提供术前精确的穿支定位,有助于优化皮瓣设计,从而在一定程度上避免因术前设计不当导致的皮瓣坏死问题,提升手术安全性。此外,分层削薄SCIP皮瓣对供区的损伤较小,有利于患肢功能的恢复,值得临床推广。
- 外科皮瓣 /
- 穿支皮瓣 /
- 显微外科手术 /
- 超声检查,多普勒,彩色 /
- 旋髂浅动脉 /
- 创面修复
Abstract: Objective To explore the clinical efficacy of layered thinning superficial circumflex iliac artery perforator (SCIP) flap based on color Doppler ultrasound (CDU) positioning. Methods The study was a retrospective observational study. From February 2023 to February 2024, 14 patients who met the inclusion criteria were admitted to the Department of Hand Surgery of Beijing Jishuitan Hospital Affiliated to Capital Medical University, including 11 males and 3 females, aged 15 to 60 years. The wound area was from 7 cm×4 cm to 14 cm×11 cm. Before the flap transplantation surgery, CDU was used to accurately locate the deep fascial exit point of the superficial branch of the superficial circumflex iliac artery. During the surgery, the SCIP flap was thinned in layers to repair the hand and forearm wounds of 11 patients and foot wounds of 3 patients. The flap incision area ranged from 8 cm×5 cm to 15 cm×12 cm. The donor area wounds of flaps were sutured directly. During the surgery, the deep fascial exit point of the superficial branch of the superficial circumflex iliac artery in the flap donor area was observed and compared with the result of CDU positioning before the surgery, and the flap thickness was measured. The flap survival and occurrence of adverse reactions were observed after the surgery. During follow-up, the appearance and texture of flaps, and the wound healing in the donor area was observed. At the last follow-up, the function of the wrist and hand in the affected limbs was evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the function of the foot and ankle in the affected limbs was evaluated according to the scoring standard of American Orthopaedic Foot and Ankle Society. Results During the surgery, the deep fascial exit point of the superficial branch of the superficial circumflex iliac artery in the flap donor area was consistent with the result of CDU positioning before the surgery, and the distance between them was less than 10 mm. The flap thickness was 5 to 8 mm with an average of 6.2 mm. All the flaps survived after surgery. During the follow-up of 5 to 12 months, the flaps had good appearance and texture, all the wounds in the donor areas healed with only linear scar left. At the last follow-up, the function of the wrist and hand in the affected limbs was evaluated as excellent in 9 cases, good in one case, and fair in one case; the function of the foot and ankle in the affected limbs was evaluated as excellent in one case and good in two cases. Conclusions CDU examination can provide precise preoperative perforator positioning for layered thinning of SCIP flap and contribute to the optimization of flap design, so as to avoid the problem of flap necrosis caused by improper preoperative design to some extent and improve the safety of surgery. In addition, the layered thinning SCIP flap results in less damage to the donor area and is beneficial for the recovery of the affected limb function, which is worthy of clinical promotion.
- Surgical flaps /
- Perforator flap /
- Microsurgery /
- Ultrasonography, Doppler, color /
- Superficial circumflex iliac artery /
- Wound repair
张文桐：酝酿和设计研究,实施手术,数据采集与分析,撰写、修改文章；杨勇：实施手术,修改、指导文章,经费支持；李峰、李斌：实施手术,数据采集与分析；王丹丹、陈涛：数据采集与分析,撰写文章；李建峰：实施手术,分析数据,撰写文章

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图 1 采用分层削薄旋髂浅动脉穿支皮瓣修复例1患者右手背皮肤软组织缺损的效果。1A.皮瓣移植术前行彩色多普勒超声定位旋髂浅动脉穿支位置并记录频谱图像；1B.皮瓣移植术前可见右手背皮肤软组织缺损；1C.术前根据穿支定位及缺损大小设计皮瓣；1D.术中皮瓣切取后,可见旋髂浅动脉浅支血管及旋髂浅静脉；1E.皮瓣移植到受区后血运良好；1F.随访9个月,皮瓣外观和质地良好；1G.随访9个月,患肢功能良好；1H.随访9个月,皮瓣供区愈合良好,仅遗留线性瘢痕

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图 2 采用分层削薄旋髂浅动脉穿支皮瓣修复例2患者右手背皮肤软组织缺损的效果。2A.皮瓣移植术前行彩色多普勒超声定位旋髂浅动脉穿支位置并记录频谱图像；2B.皮瓣移植术前可见右手背皮肤软组织缺损；2C.术前根据穿支定位及缺损大小设计皮瓣；2D.术中皮瓣切取后,可见旋髂浅动脉浅支血管及旋髂浅静脉；2E.皮瓣移植到受区后血运良好；2F.随访12个月,皮瓣外观和质地良好；2G.随访12个月,患肢功能良好；2H.随访12个月,皮瓣供区愈合良好,仅遗留线性瘢痕

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