Efficacy of free multiple lateral crural perforator flaps on one side under CDU precise localization for repairing multiple wounds at different sites on the finger
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摘要:
目的 探讨彩色多普勒超声（CDU）精准定位下游离一侧多个腿外侧穿支皮瓣修复手指不同部位多个创面的效果。 方法 该研究为回顾性病例系列研究,2018年4月—2022年10月,苏州瑞华骨科医院收治20例符合入选标准手指不同部位3、4个创面的患者,其中男15例、女5例,年龄26~59岁。术前行CDU精准定位穿支,术中清创后单个创面面积为1.8 cm×1.2 cm~8.0 cm×4.0 cm,切取游离一侧多个小腿外侧穿支皮瓣修复创面,单个皮瓣切取面积为2.0 cm×1.3 cm~9.0 cm×4.2 cm。将供区创面直接缝合。术中记录穿支入皮点与CDU定位穿支标记点的距离、穿支动脉管径、血管蒂长度、血管内膜情况、穿支来源。术后记录皮瓣发生血管危象情况、成活情况。随访记录供受区恢复情况。末次随访时,采用英国医学研究会感觉功能评定标准评定皮瓣感觉功能,采用皮瓣综合评价量表评定皮瓣修复效果。 结果 术中见穿支入皮点与CDU定位穿支标记点距离0~5 mm,穿支动脉管径0.3~0.7 mm,血管蒂长度3~8 cm,血管内膜均光滑、平整、有弹性。51条穿支来源于腓浅动脉,8条穿支来源于胫前动脉,6条穿支来源于腓动脉。术后2个皮瓣发生动脉危象,经手术探查重新吻合动脉后成活；其余皮瓣均成活。术后随访4~14个月,皮瓣质地好、外形无明显臃肿、色泽与受区无明显差别,供受区无疼痛、瘢痕无明显增生。末次随访时,皮瓣感觉功能评级为S2级者31个、S3级者34个；皮瓣修复效果为优者21个、良者44个。 结论 小腿外侧皮穿支血管具有数量多、管径粗、血管蒂长、内膜质量好、源动脉多等优点。于CDU精准定位下游离一侧多个小腿外侧穿支皮瓣修复手指不同部位多个创面,手术风险小,皮瓣修复效果佳,供区数量少、损伤小。 Abstract:Objective To explore the efficacy of free multiple lateral crural perforator flaps on one side under color Doppler ultrasound (CDU) precise localization for repairing multiple wounds at different sites on the finger. Methods This study was a retrospective study of case series. From April 2018 to October 2022, 20 patients with 3 or 4 wounds at different sites on the finger who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital. There were 15 males and 5 females, aged 26 to 59 years. Preoperative CDU-guided precise perforator localization was performed. After intraoperative debridement, the single wound area ranged from 1.8 cm×1.2 cm to 8.0 cm×4.0 cm. Free multiple lateral crural perforator flaps on one side were harvested to repair the wounds, with the area of single flap resected ranging from 2.0 cm×1.3 cm to 9.0 cm×4.2 cm. The donor site wounds were closed by direct suturing. During surgery, the distance between perforator entry point and CDU-marked perforator location, perforator artery diameter, pedicle length, tunica intima condition, and perforator origin were recorded. After surgery, the occurrence of vascular crisis and flap survival were recorded. The wound recovery in recipient and donor areas were recorded during follow-up. At the final follow-up, the sensory function of the flaps was assessed by the sensory function evaluation standard of the British Medical Research Council, and the flap repair outcome was evaluated using a flap comprehensive assessment scale. Results During surgery, the distances between perforator entry point and CDU-marked perforator location ranged from 0 to 5 mm, the perforator artery diameters ranged from 0.3 to 0.7 mm, the pedicle lengths ranged from 3 to 8 cm, and the tunica intima was smooth, flat, and elastic. Fifty-one perforators were originated from the superficial peroneal artery, 8 perforators were originated from the anterior tibial artery, and 6 perforators were originated from the peroneal artery. After surgery, two flaps developed arterial crisis, which both survived after surgical exploration and arterial reanastomosis. The other flaps survived. During follow-up of 4-14 months, the flaps exhibited good texture, no significant swelling, and no noticeable color difference from the recipient site; neither donor nor recipient sites showed pain or significant scar hyperplasia. At the final follow-up, the sensory function rating of the flaps was graded as S2 in 31 flaps and S3 in 34 flaps, the flap repair outcome was evaluated as excellent in 21 flaps and good in 44 flaps. Conclusions The lateral cutaneous perforators of the lower leg offer several advantages, including numerous vessels, large caliber, long pedicle, high-quality endangium, and multiple source arteries. The application of free multiple lateral crural perforator flaps on one side under CDU precise localization for repairing multiple wounds at different sites on the finger has low surgical risk, excellent flap repair outcome, and minimal number and damage of donor site. -
Key words:
- Surgical flaps /
- Perforator flap /
- Hand /
- Microsurgery /
- Ultrasound, Doppler, color /
- Perforator vessel localization
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参考文献
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图 1 游离4个腓浅动脉穿支皮瓣修复例1患者右手示、中、环、小指4个创面的效果。1A.清创后,右手示、中、环、小指残端创面形成；1B.术中切取4个腓浅动脉穿支皮瓣,其中右手示、中指皮瓣为一蒂双叶型皮瓣；1C.术中将皮瓣转移至受区前；1D、1E.分别为术后即刻皮瓣掌侧、背侧观；1F、1G.分别为术后10个月皮瓣掌侧、背侧观,皮瓣存活良好,外观无明显臃肿；1H.术后10个月,左小腿供区仅遗留线性瘢痕
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