经真皮下入路切取旋髂浅动脉PSP皮瓣修复手足部皮肤软组织缺损的临床效果

朱旭伟; 周飞亚; 丁健; 李志杰; 张文振; 李士

doi:10.3760/cma.j.cn501225-20241215-00487

经真皮下入路切取旋髂浅动脉PSP皮瓣修复手足部皮肤软组织缺损的临床效果

doi: 10.3760/cma.j.cn501225-20241215-00487

温州医科大学附属第二医院创面修复科,温州　325027

基金项目:

浙江省基础公益研究计划项目 LY24H110002

温州市科技局基础性科研项目 YC20250543

详细信息

通讯作者:
李士,Email：Lister@wmu.edu.cn

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出版历程
- 收稿日期: 2024-12-15
- 网络出版日期: 2026-04-30

Clinical effects of harvesting superficial iliac circumflex artery PSP flaps via subdermal approach in repairing skin and soft tissue defects in hands and feet

Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China

Funds:

Basic Public Welfare Research Program of Zhejiang Province LY24H110002

Basic Research Project of Wenzhou Science and Technology Bureau YC20250543

More Information

Corresponding author: Li Shi, Email: Lister@wmu.edu.cn

摘要

摘要: 目的探讨经真皮下入路切取旋髂浅动脉纯皮肤穿支（PSP）皮瓣修复手足部皮肤软组织缺损的临床安全性和效果。方法该研究为回顾性病例系列研究。2022年3月—2024年2月,温州医科大学附属第二医院创面修复科收治14例符合入选标准的手足部皮肤软组织缺损患者,共15个创面。清创后创面面积为5.6 cm×1.9 cm~14.0 cm×7.0 cm。术前通过高频超声定位穿支,术中经真皮下入路切取15个旋髂浅动脉纯皮肤穿支皮瓣修复创面,皮瓣切取时间为37~140 min,皮瓣切取面积为5.6 cm×1.9 cm~14.0 cm×7.0 cm,并进行供受区血管吻合。将皮瓣供区创面直接缝合。术后观察皮瓣成活情况。记录术后并发症发生情况。末次随访时,采用利克特5级量表,从整体美学外观、与周围组织的轮廓相似度、与周围组织的颜色相似度、与周围组织的质地相似度4个方面对皮瓣进行评价。结果 15个皮瓣术后均顺利成活。1个皮瓣出现紫斑,经换药后稳定。1个皮瓣发生静脉危象,经探查手术后恢复正常。1例患者供区创面延迟愈合,予以清创换药后1周顺利愈合。末次随访时,皮瓣整体美学外观评分为3.3~5.0分（平均4.5分）,与周围组织的轮廓相似度评分为3.7~5.0分（平均4.7分）,与周围组织的颜色相似度评分为3.3~5.0分（平均4.5分）,与周围组织的质地相似度评分为3.7~5.0分（平均4.8分）。结论经真皮下入路切取旋髂浅动脉PSP皮瓣修复手足部皮肤软组织缺损,术后皮瓣均成活且其外观、轮廓、颜色及质地良好,是一个安全、可行的手术方式。
- 穿支皮瓣 /
- 四肢 /
- 纯皮肤穿支 /
- 旋髂浅动脉 /
- 创面修复
Abstract: Objective To investigate the safety and effects of harvesting superficial iliac circumflex artery pure skin perforator (PSP) flaps via subdermal approach in repairing skin and soft tissue defects in hands and feet. Methods This study was a retrospective case series study. From March 2022 to February 2024, 14 patients with 15 skin and soft tissue defect wounds in hands and feet who met the inclusion criteria were admitted to the Department of Wound Repair of the Second Affiliated Hospital of Wenzhou Medical University. After debridement, the wound areas ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Before surgery, the perforators were located using high-frequency ultrasound. During surgery, 15 superficial circumflex iliac artery PSP flaps were harvested via the subdermal approach for repairing the wounds. The flap harvesting time ranged from 37 to 140 minutes, and the flap sizes ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Vascular anastomosis was performed between the donor and recipient sites. The donor site wounds were closed by direct suturing. After surgery, the survival of flaps was observed, and the occurrence of complications was recorded. At the final follow-up, the 5-point Likert scale was used to evaluate the flaps from four aspects: overall aesthetic appearance, contour similarity to surrounding tissue, color similarity to surrounding tissue, and texture similarity to surrounding tissue. Results All 15 flaps survived successfully after surgery. One flap developed purple plaque,whicts stabilized after dressing chanes.One flap developed venous crisis, which alleviated after surgery. One patient experienced delayed healing of the donor site wound, which successfully healed one week after debridement and dressing changes. At the final follow-up, the overall aesthetic appearance score of the flaps ranged from 3.3 to 5.0, with an average of 4.5; the contour similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.7; the color similarity to surrounding tissue ranged from 3.3 to 5.0, with an average of 4.5; the texture similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.8. Conclusions Harvesting the superficial iliac circumflex artery PSP flaps via the subdermal approach for repairing skin and soft tissue defects in hands and feet is a safe and feasible surgery as that all the flaps survived after surgery, with favorable aesthetic appearance, contour, color, and texture.
- Perforator flap /
- Extremities /
- Pure skin perforator /
- Superficial circumflex iliac artery /
- Wound repair
朱旭伟、李士：参与手术、研究设计、论文撰写及修改、图片制作、经费支持；周飞亚、李志杰：手术指导、论文修改；丁健：文献查找、论文修改、经费支持；张文振：参与手术、收集病例

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参考文献(38)

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图 1 经真皮下入路切取以旋髂浅动脉浅支为蒂的纯皮肤穿支皮瓣的示意图

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图 2 经真皮下入路切取以旋髂浅动脉浅支为蒂的纯皮肤穿支皮瓣修复例1患者右手示指创面的效果。2A.术前创面外观；2B.经真皮下入路显露纯皮肤穿支；2C.游离纯皮肤穿支；2D.游离旋髂浅动脉浅支；2E.皮瓣切取完成后；2F.术后即刻,皮瓣血运良好；2G.术后2周,皮瓣成活；2H.术后6个月,皮瓣外形良好

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图 3 经真皮下入路切取以旋髂浅动脉浅支和深支为蒂的纯皮肤穿支皮瓣修复例2患者右手毁损伤创面的效果。3A.术前创面外观；3B.术前用高频超声定位纯皮肤穿支（图上方的红点处）；3C.术前根据创面大小及定位的纯皮肤穿支设计皮瓣；3D.术中经真皮下入路切取皮瓣,保护纯皮肤穿支；3E.术中游离皮瓣及纯皮肤穿支后,可见除纯皮肤穿支周围外,其余部位没有脂肪；3F.游离皮瓣及纯皮肤穿支后从侧面观察皮瓣厚度；3G.术后即刻可见皮瓣血运良好；3H.术后6个月,皮瓣外观良好

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