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摘要:
目的 探讨分叶腹股沟皮瓣游离移植的临床应用效果。 方法 该研究为回顾性观察性研究。2019年7月—2024年4月,武汉大学同仁医院暨武汉市第三医院收治有1个部位创面符合入选标准的34例皮肤缺损创面患者,其中男28例、女6例,年龄26~59岁,受区创面面积为3.0 cm×2.0 cm~25.0 cm×20.0 cm。对19例患者行以旋髂浅动脉的分支为蒂分叶的腹股沟皮瓣切取,对15例患者行以旋髂浅动脉和腹壁浅动脉主干为蒂分叶的腹股沟皮瓣切取,皮瓣总面积为6.0 cm×2.2 cm~27.0 cm×23.0 cm。将皮瓣分成2~4叶,各个分叶面积为2.0 cm×1.0 cm~17.0 cm×12.0 cm。将皮瓣各个分叶重新组合、拼接或直接移植于创面,将供区创面分层缝合。术后观察皮瓣分叶成活情况、受供区创面愈合情况,随访受供区创面恢复情况。末次随访时,采用利克特5级量表评价患者对疗效的满意度。 结果 术后4例患者均有1个皮瓣分叶的尖端出现少量坏死,经修整后愈合；其余30例患者的皮瓣成活。受区创面均顺利愈合。3例患者的供区缝合口边缘出现少量坏死,经局部修整+换药后愈合；其余31例患者的供区创面愈合良好。随访6~42个月,受区均恢复良好,供区外形良好。末次随访时,患者中对疗效非常满意者15例、比较满意者15例、一般满意者4例。 结论 通过术前超声检查定位,根据血管走行设计腹股沟皮瓣,以旋髂浅动脉的分支为蒂进行皮瓣分叶或以旋髂浅动脉和腹壁浅动脉主干为蒂进行皮瓣分叶,其解剖过程可靠,分叶后的皮瓣血运丰富,可满足各类皮肤缺损创面的修复需求,且修复效果较佳,供区损伤小,值得推广。 Abstract:Objective To investigate the clinical application effects of free transplantation of lobulated inguinal flaps. Methods This study was a retrospective observational study. From July 2019 to April 2024, 34 patients with skin defect wounds whose wounds in one part met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 28 males and 6 females, aged 26 to 59 years. The wound area in the recipient area ranged from 3.0 cm×2.0 cm to 25.0 cm×20.0 cm. The lobulated inguinal flap pedicled with the branch of the superficial circumflex iliac artery were obtained in 19 patients, and the lobulated inguinal flap pedicled with the main artery of the superficial circumflex iliac artery and the superficial inferior epigastric artery were obtained in 15 patients. The total area of the flaps ranged from 6.0 cm×2.2 cm to 27.0 cm×23.0 cm. The flaps were divided into 2 to 4 lobes, and the area of each lobe ranged from 2.0 cm×1.0 cm to 17.0 cm×12.0 cm. Each lobe of the flaps was reassembled, spliced, or directly transplanted onto the wounds, and the donor wounds were sutured in layers. The survival of each lobe of the flaps and wound healing in the recipient and donor areas were observed, and the wound recovery in the recipient and donor areas were followed up. At the last follow-up, the patient's satisfaction with the efficacy was assessed by 5-grade Likert scale. Results A small amount of necrosis appeared in the tip of one lobe of the flaps in 4 patients after surgery, which healed after trimming. The flaps of the remaining 30 patients survived. The wounds in the recipient areas healed smoothly. There was a small amount of necrosis at the suture edge of the donor areas in 3 patients, which healed after local trimming and dressing change. The donor wounds healed well in the remaining 31 patients. During the follow-up of 6 to 42 months, all the recipient wounds were well repaired, and the shape of the donor areas was good. At the last follow-up, 15 patients were very satisfied with the efficacy, 15 were relatively satisfied, and 4 were generally satisfied. Conclusions Through preoperative ultrasonic examination and positioning, the inguinal flap is designed according to the course of blood vessels and lobulated with the branch of the superficial circumflex iliac artery or the main artery of the superficial circumflex iliac artery and the superficial inferior epigastric artery as the pedicles. The anatomical process is reliable and the blood flow of the flap after being lobulated is rich, which can meet the repair needs of various skin defect wounds. The repair effect is good, and the damage in the donor area is small, which is worthy of promotion. -
参考文献
(40) [1] LuoZ, QingL, ZhouZ, et al. Reconstruction of large soft tissue defects of the extremities in children ssing the kiss deep Inferior epigastric artery perforator flap to achieve primary closure of donor site[J]. Ann Plast Surg, 2019,82(1):64-70. DOI: 10.1097/SAP.0000000000001659. [2] 陈珺,章一新.章氏超减张缝合在闭合高张力创面中的临床应用效果[J].中华烧伤杂志,2020,36(5):339-345.DOI: 10.3760/cma.j.cn501120-20200314-00163. [3] PukancsikD, KelemenP, GulyásG, et al. Clinical experiences with the use of ULTRAPRO® mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: a retrospective cohort study[J]. Eur J Surg Oncol, 2017,43(7):1244-1251. DOI: 10.1016/j.ejso.2017.01.236. [4] XingW,QianJ,WangB,et al.Auricular reconstruction with modified expanded two-flap method in Goldenhar Syndrome: 7-year experiences[J].Int J Pediatr Otorhinolaryngol,2020,139:110228.DOI: 10.1016/j.ijporl.2020.110228. [5] 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. [6] 杜伟力,沈余明,胡骁骅,等.供瓣区美学修复方法的探讨[J].中华烧伤杂志,2020,36(2):97-105.DOI: 10.3760/cma.j.issn.1009-2587.2020.02.004. [7] 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. [8] 罗高杰,唐举玉,卿黎明.分叶穿支皮瓣的临床应用进展[J].中华显微外科杂志,2022,45(3):346-351.DOI: 10.3760/cma.j.cn441206-20220302-00043. [9] 张明华,周映玲,薛建波,等.游离腹股沟分叶皮瓣在手部复杂创面修复中的应用[J].中华手外科杂志,2023,39(1):30-32.DOI: 10.3760/cma.j.cn311653-20211228-00387. [10] 狄海萍,邢培朋,郑军杰,等.超薄股前外侧皮瓣一期分指修复手掌合并多指创面的疗效[J].中华烧伤与创面修复杂志,2023,39(9):835-841.DOI: 10.3760/cma.j.cn501225-20221129-00514. [11] 宋达疆,李赞,周晓,等.分叶股前外侧穿支皮瓣修复口腔复杂洞穿缺损[J].中华整形外科杂志,2019,35(10):978-985.DOI: 10.3760/cma.j.issn.1009-4598.2019.10.006. [12] 张伟,谢卫国,杨飞,等.游离股前外侧穿支皮瓣分叶移植在四肢电烧伤治疗中的临床应用[J].中华烧伤杂志,2019,35(11):790-797.DOI: 10.3760/cma.j.issn.1009-2587.2019.11.005. [13] 吴攀峰,唐举玉,卿黎明,等.股前外侧穿支皮瓣组合移植修复上肢巨大面积皮肤软组织缺损[J].中华手外科杂志,2020,36(5):369-373.DOI: 10.3760/cma.j.cn311653-20191028-00297. [14] LiRG, ZengCJ, YuanS, et al. Reconstruction of large area of deep wound in the foot and ankle with chimeric anterolateral thigh perforator flap[J]. Orthop Surg, 2021,13(5):1609-1617. DOI: 10.1111/os.13046. [15] 牟勇,黎路根,胡春兰,等.削薄分叶股前外侧穿支皮瓣修复四肢复杂软组织缺损[J].中华显微外科杂志,2019,42(3):218-222.DOI: 10.3760/cma.j.issn.1001-2036.2019.03.003. [16] 梁涛,唐金明,潘军华,等.分叶股前外侧穿支皮瓣修复踝关节周围大面积软组织缺损11例[J].中华显微外科杂志,2024,47(1):22-27.DOI: 10.3760/cma.j.cn441206-20230507-00079. [17] LiKW,LiuJ,LiuMJ,et al.Free multilobed posterior interosseous artery perforator flap for multi-finger skin defect reconstruction[J].J Plast Reconstr Aesthet Surg,2015,68(1):9-16.DOI: 10.1016/j.bjps.2014.08.063. [18] XiongY,XiongQ,QingLM,et al.Special-form radial collateral artery perforator flaps for the reconstruction of complex hand defects[J].J Orthop Surg Res,2024,19(1):533.DOI: 10.1186/s13018-024-05024-z. [19] 张警泓,刘剑毅,江旭品,等.采用扩张桡动脉分叶皮瓣美学修复面部严重瘢痕挛缩畸形[J].中国美容整形外科杂志,2023,34(11):641-646,663.DOI: 10.3969/j.issn.1673-7040.2023.11.001. [20] RostiA,AmmarA,PignattiM,et al.SCIP flap in head and neck reconstruction after oncologic ablative surgery: a systematic review[J].Eur Arch Otorhinolaryngol,2024,281(3):1083-1093.DOI: 10.1007/s00405-023-08287-0. [21] 徐军辉,张伟,周锦秀,等.游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果[J].中华烧伤与创面修复杂志,2023,39(11):1030-1037.DOI: 10.3760/cma.j.cn501225-20230804-00039. [22] 吴健,周鑫,欧昌良,等.游离旋髂浅动脉分叶皮瓣修复手部不规则创面的临床应用研究[J].创伤外科杂志,2021,23(8):629-632.DOI: 10.3969/j.issn.1009-4237.2021.08.014. [23] 崔瑛,郭玲,张晓宁,等.带蒂双叶髂腹股沟皮瓣修复手或前臂软组织缺损12例[J].中华显微外科杂志,2017,40(6):570-572.DOI: 10.3760/cma.j.issn.1001-2036.2017.06.014. [24] KimHB, MinJC, PakCJ, et al. Maximizing the versatility of thin flap from the groin area as a workhorse flap: the selective use of superficial circumflex iliac artery perforator (SCIP) free flap and superficial inferior epigastric artery (SIEA) free flap with precise preoperative planning[J]. J Reconstr Microsurg, 2023,39(2):148-155. DOI: 10.1055/a-1887-7274. [25] TothBA,ElliottLF.Aesthetic refinements in reconstructive microsurgery[J].Ann Plast Surg,1989,22(2):117-125.DOI: 10.1097/00000637-198902000-00006. [26] 刘峰,张伟,谢卫国,等.微型游离腹股沟穿支皮瓣修复手部小型创面的效果[J].中华烧伤与创面修复杂志,2023,39(10):933-938.DOI: 10.3760/cma.j.cn501225-20230701-00244. [27] ParkSY, LeeKT. Use of the superthin superficial circumflex iliac artery perforator flap for reconstruction of lower lip defects[J]. Plast Reconstr Surg, 2024,154(3):585e-588e. DOI: 10.1097/PRS.0000000000010978. [28] 杨安,陈朝阳,肖媛.腹前外侧壁跨区穿支皮瓣设计的应用解剖学研究[J].深圳中西医结合杂志,2020,30(7):22-23.DOI: 10.16458/j.cnki.1007-0893.2020.07.011. [29] LichtenbergNJ,B S,TaylorDM.Pedicled chimeric superficial circumflex iliac artery perforator (SCIP) flap with external oblique fascia for vesicocutaneous bladder fistula repair: a case report and literature review on the utility of pedicled chimeric SCIP[J].Microsurgery,2024,44(2):e31138.DOI: 10.1002/micr.31138. [30] 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. [31] HuC, HouB, HuangX, et al. Superficial circumflex iliac artery perforator flap with bilobed design for the donor defect after wrap-around flap transfer reconstruction[J]. Orthop Surg, 2023,15(3):899-905. DOI: 10.1111/os.13663. [32] HurwitzDJ, KruchevskyD. Maximizing the TULUA abdominoplasty with oblique flankplasty[J]. Clin Plast Surg, 2024,51(1):71-80. DOI: 10.1016/j.cps.2023.06.012. [33] LiZ,ZhengD,ZhengJ,et al.Free superficial circumflex iliac artery perforator flap with a single-pedicle bilobed design for pediatric multi-digit defect reconstruction[J].J Orthop Surg Res,2020,15(1):216.DOI: 10.1186/s13018-020-01733-3. [34] HongJP. The superficial circumflex iliac artery perforator flap in lower extremity reconstruction[J]. Clin Plast Surg, 2021,48(2):225-233. DOI: 10.1016/j.cps.2020.12.005. [35] OuCL,LiJ,ZhouX,et al.Repair of multiple hand defects with superficial circumflex iliac artery perforator flap[J].Injury,2023,54(3):940-946.DOI: 10.1016/j.injury.2023.01.016. [36] 陈斓,张伟,谢卫国,等.扩张髂腹股沟皮瓣游离移植整复大面积烧伤后严重瘢痕挛缩畸形的临床效果[J].中华烧伤与创面修复杂志,2022,38(4):321-327.DOI: 10.3760/cma.j.cn501225-20220210-00021. [37] 张丕红.浅谈薄型穿支皮瓣切取与穿支血管探测和皮瓣血运评估[J].中华烧伤与创面修复杂志,2023,39(10):911-918.DOI: 10.3760/cma.j.cn501225-20230812-00047. [38] FanS, ZhangHQ, LiQX, et al. The use of a honeycomb technique combined with ultrasonic aspirators and indocyanine green fluorescence angiography for a superthin anterolateral thigh flap: a pilot study[J]. Plast Reconstr Surg, 2018, 141(6):902e-910e. DOI: 10.1097/PRS.0000000000004411. [39] 常树森,莫小金,魏在荣,等.遵义缝合法在股前外侧皮瓣供区缝合中的应用研究[J].中国修复重建外科杂志,2021,35(4):477-482.DOI: 10.7507/1002-1892.202008101. [40] 杜伟力,沈余明,陈忠,等.多部位电烧伤毁损性创面修复方法的探讨[J/CD].中华损伤与修复杂志(电子版),2024,19(2):99-105.DOI: 10.3877/cma.j.issn.1673-9450.2024.02.002. -
图 1 分叶腹股沟皮瓣游离移植修复例1患者左手热压伤创面的效果。1A.术前见左手指背肌腱损伤、指间关节外露；1B.右侧腹股沟皮瓣术前分叶设计；1C.皮瓣断蒂前吲哚菁绿荧光血管造影显示血管蒂的血流灌注达皮瓣各个分叶的远端（箭头所示）；1D.切取完成的皮瓣各个分叶的血管蒂共干；1E.皮瓣切取后分层缝合供区；1F、1G.分别为移植完毕即刻皮瓣正面观、侧面观；1H、1I、1J.分别显示随访6个月时,左手背形态良好、指屈曲功能正常和供区创面愈合良好
图 2 分叶腹股沟皮瓣游离移植修复例2患者右手热压伤创面的效果。2A、2B.分别为右手拇指和手背清创后皮肤缺损创面情况,可见拇指指间关节外露；2C.术中见旋髂浅动脉发出皮支进入皮瓣的2个独立分叶；2D.随访10个月时,右手皮瓣稍臃肿,拇指指甲生长不良；2E.末次随访时,供区外形良好
图 3 分叶腹股沟皮瓣游离移植修复例3患者头部瘢痕癌创面的效果。3A.术前见头枕部瘢痕慢性溃疡创面菜花样生长；3B.头部溃疡和瘢痕切除后即刻,颅骨结构完好；3C.术中设计切取左侧分叶腹股沟皮瓣；3D、3E.分别为切取后的分叶腹股沟皮瓣皮肤面观、基底面观（箭头所示为皮瓣的2个不共干的血管蒂）；3F.皮瓣移植术毕即刻；3G、3H.分别为随访12个月时受区和供区,均恢复良好
Table 1. 34例不同原因所致皮肤缺损创面患者的创面部位分布（例）
原因 例数 上肢 下肢 头面颈部 瘢痕 16 5 4 7 热压伤 7 7 0 0 电烧伤 7 3 4 0 热力烧伤 2 1 1 0 酸腐蚀伤 2 1 0 1 合计 34 17 9 8 
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